- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,930.73 / $2,129.81 / $3,217.50
| Professional | | $1,930.73 | $2,129.81 | $3,217.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,456.00 / $6,547.00 / $10,130.00
| Professional | | $5,456.00 | $6,547.00 | $10,130.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,105.07 / $3,505.42 / $7,118.00
| Professional | | $2,105.07 | $3,505.42 | $7,118.00 |
- 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
- $2,324.48 / $3,786.43 / $7,768.35
| Professional | | $2,324.48 | $3,786.43 | $7,768.35 |