- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.08 / $1,054.82 / $2,916.26
| Professional | | $331.08 | $1,054.82 | $2,916.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.00 / $1,130.00 / $5,182.00
| Professional | | $836.00 | $1,130.00 | $5,182.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,254.00 / $1,695.00 / $7,773.00
| Professional | 50 | $1,254.00 | $1,695.00 | $7,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.79 / $1,271.98 / $4,149.57
| Professional | | $499.79 | $1,271.98 | $4,149.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.00 / $6,934.00 / $26,502.00
| Facility | | $6,934.00 | $6,934.00 | $26,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,124.64 / $3,643.20 / $6,232.71
| Professional | | $2,124.64 | $3,643.20 | $6,232.71 |