- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $942.36 / $971.52 / $1,452.23
| Professional | | $942.36 | $971.52 | $1,452.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,766.00 / $3,319.00 / $5,136.00
| Professional | | $2,766.00 | $3,319.00 | $5,136.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.30 / $1,761.76 / $2,445.06
| Professional | | $1,079.30 | $1,761.76 | $2,445.06 |
- 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
- $1,087.18 / $1,970.79 / $3,552.91
| Professional | | $1,087.18 | $1,970.79 | $3,552.91 |