- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.61 / $533.80 / $826.03
| Professional | | $510.61 | $533.80 | $826.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.00 / $1,816.00 / $2,809.00
| Professional | | $1,513.00 | $1,816.00 | $2,809.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.55 / $978.79 / $1,304.72
| Professional | | $574.55 | $978.79 | $1,304.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,188.00 / $5,188.00 / $18,767.00
| Facility | | $5,188.00 | $5,188.00 | $18,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.90 / $1,053.38 / $2,075.04
| Professional | | $634.90 | $1,053.38 | $2,075.04 |