- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.64 / $294.61 / $1,514.78
| Professional | | $291.64 | $294.61 | $1,514.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.00 / $799.00 / $3,451.00
| Professional | | $666.00 | $799.00 | $3,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.84 / $718.79 / $3,394.03
| Professional | | $421.84 | $718.79 | $3,394.03 |
- 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
- $2,308.89 / $3,331.06 / $5,541.37
| Professional | | $2,308.89 | $3,331.06 | $5,541.37 |