- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,524.40 / $2,606.84 / $3,184.63
| Professional | | $2,524.40 | $2,606.84 | $3,184.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,337.00 / $6,404.00 / $10,310.00
| Professional | | $5,337.00 | $6,404.00 | $10,310.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,188.26 / $5,096.50 / $6,463.29
| Professional | | $3,188.26 | $5,096.50 | $6,463.29 |
- 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
- $2,917.99 / $5,269.25 / $8,886.78
| Professional | | $2,917.99 | $5,269.25 | $8,886.78 |