- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,995.26 / $8,317.64
| Professional | | $1,000.00 | $1,995.26 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,754.23 / $3,311.31
| Professional | | $1,862.09 | $2,754.23 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $2,238.72
| Professional | | $1,230.27 | $1,737.80 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,128.61 / $18,197.01
| Facility | | $5,011.87 | $5,128.61 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,995.26 / $3,311.31
| Professional | | $1,096.48 | $1,995.26 | $3,311.31 |