- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.41 / $1,289.96 / $2,219.48
| Professional | | $1,005.41 | $1,289.96 | $2,219.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,620.11 / $6,620.11 / $7,931.64
| Professional | | $6,620.11 | $6,620.11 | $7,931.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.07 / $1,612.45 / $4,239.30
| Professional | | $829.07 | $1,612.45 | $4,239.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $70.00
| Professional | | $40.00 | $40.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.95 / $804.71 / $4,363.10
| Professional | | $663.95 | $804.71 | $4,363.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.45 / $3,261.00 / $3,261.00
| Professional | | $1,467.45 | $3,261.00 | $3,261.00 |