- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,912.24 / $1,961.19 / $2,932.48
| Professional | | $1,912.24 | $1,961.19 | $2,932.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,579.00 / $6,695.00 / $10,357.00
| Professional | | $5,579.00 | $6,695.00 | $10,357.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,181.34 / $3,546.25 / $5,027.43
| Professional | | $2,181.34 | $3,546.25 | $5,027.43 |
- 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
- $2,190.33 / $3,971.82 / $8,247.36
| Professional | | $2,190.33 | $3,971.82 | $8,247.36 |