- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $794.33 / $2,398.83
| Professional | | $302.00 | $794.33 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $549.54 / $549.54 / $977.24
| Professional | 50 | $549.54 | $549.54 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $8,511.38
| Facility | | $7,762.47 | $7,762.47 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $6,025.60
| Professional | | $1,949.84 | $1,949.84 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $954.99 / $4,677.35
| Professional | | $446.68 | $954.99 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $6,025.60
| Professional | | $2,187.76 | $2,187.76 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,659.59 / $3,890.45
| Professional | | $416.87 | $1,659.59 | $3,890.45 |