- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.74 / $517.98 / $577.47
| Professional | | $477.74 | $517.98 | $577.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,147.00 / $3,147.00 / $3,147.00
| Professional | | $3,147.00 | $3,147.00 | $3,147.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.31 / $2,060.31 / $2,060.31
| Facility | | $2,060.31 | $2,060.31 | $2,060.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.16 / $982.73 / $1,281.82
| Professional | | $772.16 | $982.73 | $1,281.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.13 / $625.03 / $1,272.95
| Professional | | $466.13 | $625.03 | $1,272.95 |