- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.84 / $713.73 / $867.01
| Professional | | $694.84 | $713.73 | $867.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,361.00 / $1,633.00 / $2,471.00
| Professional | | $1,361.00 | $1,633.00 | $2,471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.57 / $1,394.64 / $1,930.07
| Professional | | $975.57 | $1,394.64 | $1,930.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.00 / $6,934.00 / $26,502.00
| Facility | | $6,934.00 | $6,934.00 | $26,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.79 / $1,457.47 / $2,908.11
| Professional | | $917.79 | $1,457.47 | $2,908.11 |