- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.84 / $936.64 / $1,349.62
| Professional | | $908.84 | $936.64 | $1,349.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,596.00 / $3,115.00 / $4,820.00
| Professional | | $2,596.00 | $3,115.00 | $4,820.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,036.38 / $1,650.29 / $2,511.03
| Professional | | $1,036.38 | $1,650.29 | $2,511.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $3,239.00
| Facility | | $1,275.00 | $1,275.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,128.35 / $1,833.31 / $4,002.24
| Professional | | $1,128.35 | $1,833.31 | $4,002.24 |