- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.89 / $392.33 / $1,315.00
| Professional | | $278.89 | $392.33 | $1,315.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $690.08 / $1,972.50 / $2,163.13
| Professional | 50 | $690.08 | $1,972.50 | $2,163.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,896.08 / $2,014.08 / $2,672.44
| Facility | | $1,896.08 | $2,014.08 | $2,672.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.24 / $392.76 / $941.84
| Professional | | $204.24 | $392.76 | $941.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.04 / $400.74 / $941.84
| Professional | | $382.04 | $400.74 | $941.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.45 / $431.20 / $1,156.01
| Professional | | $352.45 | $431.20 | $1,156.01 |