- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.72 / $430.72 / $550.46
| Professional | | $430.72 | $430.72 | $550.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.00 / $2,042.00 / $2,573.00
| Professional | | $1,263.00 | $2,042.00 | $2,573.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,894.50 / $3,063.00 / $3,859.50
| Professional | 50 | $1,894.50 | $3,063.00 | $3,859.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.68 / $650.89 / $951.29
| Professional | | $500.68 | $650.89 | $951.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.23 / $1,018.33 / $1,611.98
| Professional | | $518.23 | $1,018.33 | $1,611.98 |