- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.73 / $309.73 / $490.38
| Professional | | $309.73 | $309.73 | $490.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.00 / $1,482.00 / $2,271.00
| Professional | | $917.00 | $1,482.00 | $2,271.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,375.50 / $2,223.00 / $3,406.50
| Professional | 50 | $1,375.50 | $2,223.00 | $3,406.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.29 / $599.65 / $884.97
| Professional | | $410.29 | $599.65 | $884.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.91 / $882.29 / $1,441.44
| Professional | | $406.91 | $882.29 | $1,441.44 |