- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.92 / $273.13 / $1,840.34
| Professional | | $50.92 | $273.13 | $1,840.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.00 / $704.00 / $2,109.00
| Professional | | $587.00 | $704.00 | $2,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.13 / $618.62 / $1,645.76
| Professional | | $382.13 | $618.62 | $1,645.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,200.00 / $14,634.00
| Facility | | $4,200.00 | $4,200.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.14 / $1,987.84 / $3,120.48
| Professional | | $1,078.14 | $1,987.84 | $3,120.48 |