- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.07 / $923.25 / $1,034.46
| Professional | | $376.07 | $923.25 | $1,034.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.00 / $1,426.00 / $1,606.00
| Professional | | $882.00 | $1,426.00 | $1,606.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,323.00 / $2,139.00 / $2,409.00
| Professional | 50 | $1,323.00 | $2,139.00 | $2,409.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.38 / $1,303.69 / $1,936.05
| Professional | | $487.38 | $1,303.69 | $1,936.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.21 / $1,046.97 / $3,898.70
| Professional | | $580.21 | $1,046.97 | $3,898.70 |