- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.53 / $1,502.22 / $2,099.46
| Professional | | $1,424.53 | $1,502.22 | $2,099.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,066.00 / $4,879.00 / $7,549.00
| Professional | | $4,066.00 | $4,879.00 | $7,549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,601.53 / $2,574.61 / $3,796.80
| Professional | | $1,601.53 | $2,574.61 | $3,796.80 |
- 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
- $1,832.89 / $2,926.25 / $6,400.67
| Professional | | $1,832.89 | $2,926.25 | $6,400.67 |