- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.60 / $2,098.38 / $3,104.66
| Professional | | $2,041.60 | $2,098.38 | $3,104.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,994.00 / $7,193.00 / $11,129.00
| Professional | | $5,994.00 | $7,193.00 | $11,129.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,357.21 / $3,800.63 / $5,408.53
| Professional | | $2,357.21 | $3,800.63 | $5,408.53 |
- 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
- $2,145.29 / $4,051.80 / $7,876.69
| Professional | | $2,145.29 | $4,051.80 | $7,876.69 |