- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.05 / $2,597.73 / $3,705.84
| Professional | | $2,510.05 | $2,597.73 | $3,705.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,080.00 / $8,496.00 / $13,145.00
| Professional | | $7,080.00 | $8,496.00 | $13,145.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,738.29 / $4,550.50 / $6,567.12
| Professional | | $2,738.29 | $4,550.50 | $6,567.12 |
- 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
- $3,123.11 / $4,969.93 / $11,094.60
| Professional | | $3,123.11 | $4,969.93 | $11,094.60 |