- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,556.09 / $2,653.10 / $3,875.14
| Professional | | $2,556.09 | $2,653.10 | $3,875.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,110.00 / $8,532.00 / $13,201.00
| Professional | | $7,110.00 | $8,532.00 | $13,201.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,683.63 / $4,608.64 / $6,548.10
| Professional | | $2,683.63 | $4,608.64 | $6,548.10 |
- 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
- $3,095.63 / $4,808.21 / $9,499.08
| Professional | | $3,095.63 | $4,808.21 | $9,499.08 |