- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,367.59 / $3,494.31 / $4,995.58
| Professional | | $3,367.59 | $3,494.31 | $4,995.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,618.00 / $11,542.00 / $17,856.00
| Professional | | $9,618.00 | $11,542.00 | $17,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,870.14 / $6,101.17 / $8,813.53
| Professional | | $3,870.14 | $6,101.17 | $8,813.53 |
- 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
- $4,359.30 / $6,959.74 / $14,323.32
| Professional | | $4,359.30 | $6,959.74 | $14,323.32 |