- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.41 / $460.41 / $593.99
| Professional | | $460.41 | $460.41 | $593.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.00 / $2,182.00 / $2,778.00
| Professional | | $1,350.00 | $2,182.00 | $2,778.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,025.00 / $3,273.00 / $4,167.00
| Professional | 50 | $2,025.00 | $3,273.00 | $4,167.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.28 / $755.66 / $1,104.42
| Professional | | $581.28 | $755.66 | $1,104.42 |
- 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
- $624.80 / $1,274.83 / $1,877.18
| Professional | | $624.80 | $1,274.83 | $1,877.18 |