- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.33 / $243.79 / $3,141.51
| Professional | | $219.33 | $243.79 | $3,141.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.00 / $783.00 / $8,992.00
| Professional | | $392.00 | $783.00 | $8,992.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.23 / $570.86 / $7,422.46
| Professional | | $333.23 | $570.86 | $7,422.46 |
- 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
- $5,391.10 / $8,135.66 / $12,938.66
| Professional | | $5,391.10 | $8,135.66 | $12,938.66 |