- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.55 / $4,706.30 / $4,706.30
| Professional | | $270.55 | $4,706.30 | $4,706.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.00 / $572.00 / $858.00
| Professional | | $482.00 | $572.00 | $858.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.93 / $434.03 / $605.90
| Professional | | $318.93 | $434.03 | $605.90 |
- 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
- $389.40 / $640.14 / $1,037.54
| Professional | | $389.40 | $640.14 | $1,037.54 |