- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,236.14 / $2,309.40 / $2,821.94
| Professional | | $2,236.14 | $2,309.40 | $2,821.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,727.00 / $5,672.00 / $9,131.00
| Professional | | $4,727.00 | $5,672.00 | $9,131.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,789.74 / $4,507.55 / $5,726.18
| Professional | | $2,789.74 | $4,507.55 | $5,726.18 |
- 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
- $3,278.59 / $4,148.43 / $7,671.29
| Professional | | $3,278.59 | $4,148.43 | $7,671.29 |