- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.42 / $936.84 / $1,396.48
| Professional | | $901.42 | $936.84 | $1,396.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,681.00 / $3,217.00 / $4,978.00
| Professional | | $2,681.00 | $3,217.00 | $4,978.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,049.86 / $1,706.55 / $2,402.69
| Professional | | $1,049.86 | $1,706.55 | $2,402.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.28 / $1,850.08 / $3,907.19
| Professional | | $1,056.28 | $1,850.08 | $3,907.19 |