- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,034.00 / $4,171.85 / $5,941.64
| Professional | | $4,034.00 | $4,171.85 | $5,941.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,507.00 / $13,808.00 / $21,364.00
| Professional | | $11,507.00 | $13,808.00 | $21,364.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,535.35 / $7,285.28 / $11,105.61
| Professional | | $4,535.35 | $7,285.28 | $11,105.61 |
- 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
- $4,600.57 / $8,010.38 / $16,065.37
| Professional | | $4,600.57 | $8,010.38 | $16,065.37 |