- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.37 / $179.37 / $1,817.28
| Professional | | $179.37 | $179.37 | $1,817.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.00 / $473.00 / $4,425.00
| Professional | | $324.00 | $473.00 | $4,425.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $486.00 / $852.00 / $6,637.50
| Professional | 50 | $486.00 | $852.00 | $6,637.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.14 / $455.71 / $5,148.18
| Professional | | $272.14 | $455.71 | $5,148.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,200.00 / $14,634.00
| Facility | | $4,200.00 | $4,200.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,364.74 / $5,875.74 / $14,562.57
| Professional | | $3,364.74 | $5,875.74 | $14,562.57 |