- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,028.38 / $2,113.94 / $3,079.64
| Professional | | $2,028.38 | $2,113.94 | $3,079.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,647.00 / $6,776.00 / $10,484.00
| Professional | | $5,647.00 | $6,776.00 | $10,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.23 / $3,662.61 / $5,179.72
| Professional | | $2,128.23 | $3,662.61 | $5,179.72 |
- 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
- $2,400.42 / $3,953.64 / $8,680.31
| Professional | | $2,400.42 | $3,953.64 | $8,680.31 |