- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,215.19 / $2,284.79 / $3,400.38
| Professional | | $2,215.19 | $2,284.79 | $3,400.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,528.00 / $7,834.00 / $12,120.00
| Professional | | $6,528.00 | $7,834.00 | $12,120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,556.33 / $4,060.90 / $6,381.64
| Professional | | $2,556.33 | $4,060.90 | $6,381.64 |
- 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
- $2,543.77 / $4,653.34 / $9,339.00
| Professional | | $2,543.77 | $4,653.34 | $9,339.00 |