- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.68 / $130.50 / $201.02
| Professional | | $75.68 | $130.50 | $201.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.00 / $702.00 / $1,123.00
| Professional | | $434.00 | $702.00 | $1,123.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $651.00 / $1,053.00 / $1,684.50
| Professional | 50 | $651.00 | $1,053.00 | $1,684.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.04 / $289.44 / $433.46
| Professional | | $198.04 | $289.44 | $433.46 |
- 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
- $249.17 / $514.42 / $724.09
| Professional | | $249.17 | $514.42 | $724.09 |