- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,891.56 / $4,231.97 / $6,081.96
| Professional | | $3,891.56 | $4,231.97 | $6,081.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,103.00 / $13,324.00 / $20,615.00
| Professional | | $11,103.00 | $13,324.00 | $20,615.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,375.43 / $7,030.41 / $10,301.62
| Professional | | $4,375.43 | $7,030.41 | $10,301.62 |
- 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
- $4,355.85 / $8,015.64 / $17,707.78
| Professional | | $4,355.85 | $8,015.64 | $17,707.78 |