- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,450.51 / $4,764.01 / $6,546.93
| Professional | | $4,450.51 | $4,764.01 | $6,546.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,682.00 / $15,218.00 / $23,545.00
| Professional | | $12,682.00 | $15,218.00 | $23,545.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,001.08 / $8,024.05 / $12,348.18
| Professional | | $5,001.08 | $8,024.05 | $12,348.18 |
- 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
- $4,938.57 / $8,951.15 / $17,735.88
| Professional | | $4,938.57 | $8,951.15 | $17,735.88 |