- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,415.57 / $2,493.71 / $3,048.34
| Professional | | $2,415.57 | $2,493.71 | $3,048.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,106.00 / $6,127.00 / $9,864.00
| Professional | | $5,106.00 | $6,127.00 | $9,864.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,012.38 / $4,871.33 / $6,185.65
| Professional | | $3,012.38 | $4,871.33 | $6,185.65 |
- 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
- $2,606.77 / $4,704.04 / $8,325.19
| Professional | | $2,606.77 | $4,704.04 | $8,325.19 |