- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.21 / $975.62 / $1,229.99
| Professional | | $970.21 | $975.62 | $1,229.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,861.00 / $2,233.00 / $3,378.00
| Professional | | $1,861.00 | $2,233.00 | $3,378.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.55 / $1,951.24 / $2,686.78
| Professional | | $1,326.55 | $1,951.24 | $2,686.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,509.00 / $8,509.00 / $27,952.00
| Facility | | $8,509.00 | $8,509.00 | $27,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.27 / $1,943.32 / $3,161.60
| Professional | | $1,055.27 | $1,943.32 | $3,161.60 |