- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.14 / $714.57 / $930.76
| Professional | | $703.14 | $714.57 | $930.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.00 / $1,591.00 / $2,407.00
| Professional | | $1,326.00 | $1,591.00 | $2,407.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.08 / $1,429.15 / $1,954.00
| Professional | | $985.08 | $1,429.15 | $1,954.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,188.00 / $5,188.00 / $18,767.00
| Facility | | $5,188.00 | $5,188.00 | $18,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.92 / $1,401.86 / $2,557.10
| Professional | | $838.92 | $1,401.86 | $2,557.10 |