- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $380.19 / $3,019.95
| Professional | | $204.17 | $380.19 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,258.93 / $1,778.28
| Professional | | $776.25 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $645.65 / $1,174.90 / $2,691.53
| Professional | 50 | $645.65 | $1,174.90 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $501.19 / $870.96
| Professional | | $316.23 | $501.19 | $870.96 |
- 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
- $354.81 / $645.65 / $1,202.26
| Professional | | $354.81 | $645.65 | $1,202.26 |