- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,550.92 / $2,633.54 / $3,631.17
| Professional | | $2,550.92 | $2,633.54 | $3,631.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,542.00 / $9,050.00 / $14,003.00
| Professional | | $7,542.00 | $9,050.00 | $14,003.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,961.86 / $4,754.97 / $6,372.64
| Professional | | $2,961.86 | $4,754.97 | $6,372.64 |
- 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
- $2,893.35 / $4,748.39 / $9,735.68
| Professional | | $2,893.35 | $4,748.39 | $9,735.68 |