- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.65 / $738.92 / $938.24
| Professional | | $730.65 | $738.92 | $938.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,694.40 / $5,694.40 / $5,694.40
| Facility | | $5,694.40 | $5,694.40 | $5,694.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.00 / $1,813.00 / $2,918.00
| Professional | | $1,511.00 | $1,813.00 | $2,918.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.04 / $1,497.31 / $1,887.23
| Professional | | $922.04 | $1,497.31 | $1,887.23 |
- 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
- $1,047.61 / $1,489.19 / $2,520.71
| Professional | | $1,047.61 | $1,489.19 | $2,520.71 |