- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.41 / $334.21 / $357.37
| Professional | | $48.41 | $334.21 | $357.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,026.00 / $6,026.00 / $6,026.00
| Professional | | $6,026.00 | $6,026.00 | $6,026.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,604.55 / $4,604.55 / $4,604.55
| Facility | | $4,604.55 | $4,604.55 | $4,604.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.60 / $453.25 / $591.19
| Professional | | $295.60 | $453.25 | $591.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.68 / $58.88 / $103.14
| Professional | | $44.68 | $58.88 | $103.14 |