- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,334.84 / $2,577.67 / $3,627.14
| Professional | | $2,334.84 | $2,577.67 | $3,627.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,007.00 / $8,408.00 / $13,009.00
| Professional | | $7,007.00 | $8,408.00 | $13,009.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,753.64 / $4,447.12 / $6,084.40
| Professional | | $2,753.64 | $4,447.12 | $6,084.40 |
- 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
- $2,823.85 / $4,953.07 / $10,402.91
| Professional | | $2,823.85 | $4,953.07 | $10,402.91 |