- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.23 / $537.23 / $756.29
| Professional | | $537.23 | $537.23 | $756.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,579.00 / $2,552.00 / $3,527.00
| Professional | | $1,579.00 | $2,552.00 | $3,527.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,368.50 / $3,828.00 / $5,290.50
| Professional | 50 | $2,368.50 | $3,828.00 | $5,290.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.82 / $954.60 / $1,395.18
| Professional | | $713.82 | $954.60 | $1,395.18 |
- 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
- $765.50 / $1,454.35 / $2,332.19
| Professional | | $765.50 | $1,454.35 | $2,332.19 |