- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,864.03 / $2,934.52 / $4,250.64
| Professional | | $2,864.03 | $2,934.52 | $4,250.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,161.00 / $9,793.00 / $15,151.00
| Professional | | $8,161.00 | $9,793.00 | $15,151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,247.02 / $5,179.16 / $7,396.42
| Professional | | $3,247.02 | $5,179.16 | $7,396.42 |
- 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
- $3,663.78 / $5,918.89 / $12,019.90
| Professional | | $3,663.78 | $5,918.89 | $12,019.90 |