- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $707.95 / $3,235.94
| Professional | | $309.03 | $707.95 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $891.25 / $3,467.37
| Professional | | $660.69 | $891.25 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $724.44 / $3,388.44
| Professional | | $426.58 | $724.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,918.31 / $25,703.96
| Facility | | $4,897.79 | $6,918.31 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,174.90 / $4,786.30
| Professional | | $489.78 | $1,174.90 | $4,786.30 |