- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,280.23 / $3,542.84 / $5,254.44
| Professional | | $3,280.23 | $3,542.84 | $5,254.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,114.00 / $12,137.00 / $18,778.00
| Professional | | $10,114.00 | $12,137.00 | $18,778.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,972.73 / $6,385.61 / $8,647.29
| Professional | | $3,972.73 | $6,385.61 | $8,647.29 |
- 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
- $4,135.41 / $6,822.61 / $13,588.08
| Professional | | $4,135.41 | $6,822.61 | $13,588.08 |