- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.43 / $251.43 / $444.53
| Professional | | $251.43 | $251.43 | $444.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $740.00 / $1,273.00 / $2,058.00
| Professional | | $740.00 | $1,273.00 | $2,058.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,110.00 / $1,909.50 / $3,087.00
| Professional | 50 | $1,110.00 | $1,909.50 | $3,087.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.70 / $499.40 / $823.45
| Professional | | $341.70 | $499.40 | $823.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.92 / $855.34 / $1,397.49
| Professional | | $487.92 | $855.34 | $1,397.49 |