- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,725.99 / $1,749.12 / $2,197.86
| Professional | | $1,725.99 | $1,749.12 | $2,197.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.00 / $3,973.00 / $6,011.00
| Professional | | $3,311.00 | $3,973.00 | $6,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,371.84 / $3,498.25 / $4,781.47
| Professional | | $2,371.84 | $3,498.25 | $4,781.47 |
- 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
- $2,474.98 / $3,236.34 / $5,863.00
| Professional | | $2,474.98 | $3,236.34 | $5,863.00 |