- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,578.44 / $2,641.56 / $3,925.36
| Professional | | $2,578.44 | $2,641.56 | $3,925.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,519.00 / $9,023.00 / $13,960.00
| Professional | | $7,519.00 | $9,023.00 | $13,960.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,947.50 / $4,772.52 / $6,799.19
| Professional | | $2,947.50 | $4,772.52 | $6,799.19 |
- 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
- $2,884.36 / $5,375.25 / $11,156.65
| Professional | | $2,884.36 | $5,375.25 | $11,156.65 |