- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $2,137.96 / $5,128.61
| Professional | | $100.00 | $2,137.96 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.18 / $0.21 / $0.21
| Professional | | $0.18 | $0.21 | $0.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.20 / $1.20
| Professional | | $1.20 | $1.20 | $1.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64,565.42 / $64,565.42 / $64,565.42
| Professional | | $64,565.42 | $64,565.42 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.27 / $0.28 / $50.12
| Professional | | $0.27 | $0.28 | $50.12 |