- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,413.18 / $3,585.31 / $5,034.97
| Professional | | $3,413.18 | $3,585.31 | $5,034.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,744.00 / $11,693.00 / $18,090.00
| Professional | | $9,744.00 | $11,693.00 | $18,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,835.74 / $6,173.58 / $9,067.65
| Professional | | $3,835.74 | $6,173.58 | $9,067.65 |
- 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
- $3,823.31 / $6,964.03 / $15,058.56
| Professional | | $3,823.31 | $6,964.03 | $15,058.56 |