- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.40 / $975.59 / $1,227.54
| Professional | | $967.40 | $975.59 | $1,227.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,857.00 / $2,228.00 / $3,371.00
| Professional | | $1,857.00 | $2,228.00 | $3,371.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,292.89 / $1,939.34 / $2,685.97
| Professional | | $1,292.89 | $1,939.34 | $2,685.97 |
- 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
- $1,089.98 / $1,915.45 / $3,205.81
| Professional | | $1,089.98 | $1,915.45 | $3,205.81 |