- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.59 / $732.35 / $940.18
| Professional | | $719.59 | $732.35 | $940.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.00 / $1,642.00 / $2,483.00
| Professional | | $1,368.00 | $1,642.00 | $2,483.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.81 / $1,306.21 / $1,992.07
| Professional | | $870.81 | $1,306.21 | $1,992.07 |
- 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
- $1,044.08 / $1,445.99 / $2,294.51
| Professional | | $1,044.08 | $1,445.99 | $2,294.51 |