- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.90 / $1,389.59 / $2,060.31
| Professional | | $1,355.90 | $1,389.59 | $2,060.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,972.00 / $4,766.00 / $7,374.00
| Professional | | $3,972.00 | $4,766.00 | $7,374.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,559.13 / $2,521.61 / $3,546.44
| Professional | | $1,559.13 | $2,521.61 | $3,546.44 |
- 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
- $1,584.07 / $3,100.26 / $5,866.08
| Professional | | $1,584.07 | $3,100.26 | $5,866.08 |