- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.44 / $928.80 / $1,161.00
| Professional | | $541.44 | $928.80 | $1,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.95 / $1,232.30 / $2,564.06
| Professional | | $124.95 | $1,232.30 | $2,564.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.07 / $678.70 / $7,933.12
| Facility | | $106.07 | $678.70 | $7,933.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.02 / $743.08 / $1,176.39
| Professional | | $496.02 | $743.08 | $1,176.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.66 / $744.02 / $1,070.15
| Professional | | $547.66 | $744.02 | $1,070.15 |