- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.02 / $270.02 / $440.30
| Professional | | $270.02 | $270.02 | $440.30 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $135.02 / $135.02 / $220.15
| Professional | 52 | $135.02 | $135.02 | $220.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.00 / $737.00 / $1,089.00
| Professional | | $614.00 | $737.00 | $1,089.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $921.00 / $1,245.00 / $1,633.50
| Professional | 50 | $921.00 | $1,245.00 | $1,633.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.60 / $702.26 / $1,514.78
| Professional | | $440.60 | $702.26 | $1,514.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $6,295.00 / $14,634.00
| Facility | | $4,200.00 | $6,295.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.79 / $1,418.62 / $2,658.49
| Professional | | $534.79 | $1,418.62 | $2,658.49 |