- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.64 / $537.64 / $3,614.02
| Professional | | $537.64 | $537.64 | $3,614.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.57 / $512.57 / $512.57
| Professional | | $512.57 | $512.57 | $512.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,367.93 / $4,367.93 / $4,367.93
| Facility | | $4,367.93 | $4,367.93 | $4,367.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.00 / $832.00 / $4,367.93
| Professional | | $832.00 | $832.00 | $4,367.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,068.18 / $4,664.60 / $8,413.51
| Professional | | $3,068.18 | $4,664.60 | $8,413.51 |