- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,928.30 / $1,968.49 / $2,462.52
| Professional | | $1,928.30 | $1,968.49 | $2,462.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,725.00 / $4,470.00 / $6,762.00
| Professional | | $3,725.00 | $4,470.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,715.90 / $3,936.97 / $5,393.67
| Professional | | $2,715.90 | $3,936.97 | $5,393.67 |
- 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
- $2,385.08 / $3,943.80 / $7,042.07
| Professional | | $2,385.08 | $3,943.80 | $7,042.07 |