- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.33 / $827.22 / $1,165.55
| Professional | | $471.33 | $827.22 | $1,165.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.28 / $692.23 / $944.40
| Professional | | $583.28 | $692.23 | $944.40 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $874.92 / $1,038.33 / $1,416.60
| Professional | 50 | $874.92 | $1,038.33 | $1,416.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.81 / $1,005.81 / $1,005.81
| Facility | | $1,005.81 | $1,005.81 | $1,005.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.62 / $1,158.39 / $1,488.93
| Professional | | $821.62 | $1,158.39 | $1,488.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.82 / $905.60 / $1,409.11
| Professional | | $662.82 | $905.60 | $1,409.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.33 / $706.10 / $1,137.23
| Professional | | $471.33 | $706.10 | $1,137.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.63 / $995.73 / $1,287.58
| Professional | | $702.63 | $995.73 | $1,287.58 |