- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $869.54 / $872.09 / $1,101.28
| Professional | | $869.54 | $872.09 | $1,101.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,666.00 / $1,999.00 / $3,024.00
| Professional | | $1,666.00 | $1,999.00 | $3,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,024.69 / $1,537.04 / $2,411.00
| Professional | | $1,024.69 | $1,537.04 | $2,411.00 |
- 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
- $950.72 / $1,723.91 / $2,789.79
| Professional | | $950.72 | $1,723.91 | $2,789.79 |