- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,471.46 / $3,115.62 / $4,622.41
| Professional | | $2,471.46 | $3,115.62 | $4,622.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,865.00 / $10,638.00 / $16,458.00
| Professional | | $8,865.00 | $10,638.00 | $16,458.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,446.70 / $5,205.68 / $7,700.51
| Professional | | $3,446.70 | $5,205.68 | $7,700.51 |
- 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
- $3,400.65 / $6,418.47 / $10,964.37
| Professional | | $3,400.65 | $6,418.47 | $10,964.37 |