- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.07 / $1,517.00 / $9,034.00
| Facility | | $236.07 | $1,517.00 | $9,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.38 / $416.79 / $576.69
| Professional | | $168.38 | $416.79 | $576.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $269.14 / $269.14 / $269.14
| Professional | 50 | $269.14 | $269.14 | $269.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.64 / $446.08 / $1,019.86
| Professional | | $262.64 | $446.08 | $1,019.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,650.00 / $4,233.00
| Facility | | $980.00 | $1,650.00 | $4,233.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.97 / $605.37 / $904.64
| Professional | | $443.97 | $605.37 | $904.64 |