- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,054.04 / $2,096.34 / $3,105.15
| Professional | | $2,054.04 | $2,096.34 | $3,105.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,982.00 / $7,178.00 / $11,106.00
| Professional | | $5,982.00 | $7,178.00 | $11,106.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,351.52 / $3,793.96 / $5,453.02
| Professional | | $2,351.52 | $3,793.96 | $5,453.02 |
- 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
- $2,503.51 / $4,273.07 / $8,891.51
| Professional | | $2,503.51 | $4,273.07 | $8,891.51 |