- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,563.14 / $2,613.69 / $3,784.84
| Professional | | $2,563.14 | $2,613.69 | $3,784.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,323.00 / $8,788.00 / $13,595.00
| Professional | | $7,323.00 | $8,788.00 | $13,595.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,880.68 / $4,641.33 / $6,736.98
| Professional | | $2,880.68 | $4,641.33 | $6,736.98 |
- 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
- $2,955.74 / $5,248.48 / $11,312.39
| Professional | | $2,955.74 | $5,248.48 | $11,312.39 |