- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,400.76 / $1,400.76 / $1,400.76
| Professional | | $1,400.76 | $1,400.76 | $1,400.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.00 / $2,153.00 / $2,960.00
| Professional | | $1,332.00 | $2,153.00 | $2,960.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,998.00 / $3,229.50 / $4,440.00
| Professional | 50 | $1,998.00 | $3,229.50 | $4,440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.08 / $794.86 / $1,161.72
| Professional | | $607.08 | $794.86 | $1,161.72 |
- 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
- $630.02 / $1,357.88 / $1,916.21
| Professional | | $630.02 | $1,357.88 | $1,916.21 |