- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $812.83
| Professional | | $275.42 | $446.68 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,778.28 / $2,290.87
| Professional | | $1,096.48 | $1,778.28 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $912.01 / $1,659.59 / $3,388.44
| Professional | 50 | $912.01 | $1,659.59 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $891.25
| Professional | | $407.38 | $602.56 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,630.27 / $10,471.29
| Facility | | $1,995.26 | $2,630.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $758.58 / $1,202.26
| Professional | | $389.05 | $758.58 | $1,202.26 |