- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.01 / $2,726.59 / $3,452.71
| Professional | | $1,342.01 | $2,726.59 | $3,452.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,372.00 / $11,500.00 / $26,542.00
| Facility | | $3,372.00 | $11,500.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,066.00 / $5,066.00 / $5,066.00
| Professional | | $5,066.00 | $5,066.00 | $5,066.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.66 / $964.30 / $1,454.45
| Facility | | $719.66 | $964.30 | $1,454.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,005.00 / $1,521.30
| Professional | | $5.00 | $1,005.00 | $1,521.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.66 / $964.30 / $1,467.00
| Facility | | $719.66 | $964.30 | $1,467.00 |