- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.29 / $634.77 / $679.42
| Professional | | $508.29 | $634.77 | $679.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,561.00 / $1,873.00 / $2,092.00
| Professional | | $1,561.00 | $1,873.00 | $2,092.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,341.50 / $2,892.00 / $3,138.00
| Professional | 50 | $2,341.50 | $2,892.00 | $3,138.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.93 / $1,136.29 / $1,906.34
| Professional | | $855.93 | $1,136.29 | $1,906.34 |
- 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
- $1,187.46 / $1,659.12 / $2,806.71
| Professional | | $1,187.46 | $1,659.12 | $2,806.71 |