- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.21 / $942.26 / $1,187.89
| Professional | | $937.21 | $942.26 | $1,187.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,798.00 / $2,158.00 / $3,264.00
| Professional | | $1,798.00 | $2,158.00 | $3,264.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.73 / $1,601.84 / $2,596.40
| Professional | | $1,037.73 | $1,601.84 | $2,596.40 |
- 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
- $916.52 / $1,875.75 / $2,915.67
| Professional | | $916.52 | $1,875.75 | $2,915.67 |