- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,185.01 / $1,481.26 / $2,119.15
| Professional | | $1,185.01 | $1,481.26 | $2,119.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $1,766.98 / $1,766.98
| Professional | | $150.00 | $1,766.98 | $1,766.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.96 / $1,282.45 / $2,049.63
| Facility | | $899.96 | $1,282.45 | $2,049.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.71 / $1,429.35 / $3,870.00
| Professional | | $990.71 | $1,429.35 | $3,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,247.00 / $1,247.00 / $1,247.00
| Facility | | $1,247.00 | $1,247.00 | $1,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.71 / $1,247.00 / $1,524.93
| Professional | | $990.71 | $1,247.00 | $1,524.93 |