- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.41 / $940.96 / $2,265.14
| Professional | | $300.41 | $940.96 | $2,265.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.00 / $1,004.00 / $4,090.00
| Professional | | $743.00 | $1,004.00 | $4,090.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,114.50 / $1,506.00 / $6,135.00
| Professional | 50 | $1,114.50 | $1,506.00 | $6,135.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.73 / $1,132.25 / $3,267.68
| Professional | | $442.73 | $1,132.25 | $3,267.68 |
- 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
- $1,877.43 / $2,995.84 / $5,069.89
| Professional | | $1,877.43 | $2,995.84 | $5,069.89 |