- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,650.39 / $3,095.54 / $3,893.38
| Professional | | $2,650.39 | $3,095.54 | $3,893.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,069.00 / $9,683.00 / $14,981.00
| Professional | | $8,069.00 | $9,683.00 | $14,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,172.23 / $5,118.18 / $7,024.16
| Professional | | $3,172.23 | $5,118.18 | $7,024.16 |
- 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
- $3,210.88 / $5,373.28 / $11,366.53
| Professional | | $3,210.88 | $5,373.28 | $11,366.53 |