- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,804.98 / $1,854.65 / $2,275.23
| Professional | | $1,804.98 | $1,854.65 | $2,275.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,799.00 / $4,559.00 / $7,338.00
| Professional | | $3,799.00 | $4,559.00 | $7,338.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,245.10 / $3,491.86 / $4,621.72
| Professional | | $2,245.10 | $3,491.86 | $4,621.72 |
- 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
- $2,005.64 / $3,702.74 / $6,158.09
| Professional | | $2,005.64 | $3,702.74 | $6,158.09 |