- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,617.01 / $1,639.70 / $2,080.03
| Professional | | $1,617.01 | $1,639.70 | $2,080.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,079.00 / $3,695.00 / $5,590.00
| Professional | | $3,079.00 | $3,695.00 | $5,590.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,285.40 / $3,279.39 / $4,491.14
| Professional | | $2,285.40 | $3,279.39 | $4,491.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,188.00 / $5,188.00 / $18,767.00
| Facility | | $5,188.00 | $5,188.00 | $18,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,751.27 / $3,276.64 / $5,807.08
| Professional | | $1,751.27 | $3,276.64 | $5,807.08 |