- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.39 / $490.63 / $5,880.50
| Professional | | $336.39 | $490.63 | $5,880.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.20 / $2,767.20 / $2,767.20
| Facility | | $2,767.20 | $2,767.20 | $2,767.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.00 / $933.00 / $1,411.00
| Professional | | $647.00 | $933.00 | $1,411.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.21 / $742.45 / $1,378.07
| Professional | | $451.21 | $742.45 | $1,378.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.22 / $989.76 / $1,559.98
| Professional | | $539.22 | $989.76 | $1,559.98 |