- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,027.41 / $3,027.41 / $3,600.00
| Professional | | $3,027.41 | $3,027.41 | $3,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.00 / $2,153.00 / $3,081.00
| Professional | | $1,332.00 | $2,153.00 | $3,081.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,998.00 / $3,229.50 / $4,621.50
| Professional | 50 | $1,998.00 | $3,229.50 | $4,621.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.98 / $831.01 / $1,214.56
| Professional | | $606.98 | $831.01 | $1,214.56 |
- 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
- $632.86 / $1,132.75 / $1,978.08
| Professional | | $632.86 | $1,132.75 | $1,978.08 |