- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,543.72 / $3,871.28 / $5,739.64
| Professional | | $3,543.72 | $3,871.28 | $5,739.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,093.00 / $13,312.00 / $20,596.00
| Professional | | $11,093.00 | $13,312.00 | $20,596.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,358.08 / $7,043.86 / $10,060.11
| Professional | | $4,358.08 | $7,043.86 | $10,060.11 |
- 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
- $4,368.43 / $8,675.27 / $15,067.79
| Professional | | $4,368.43 | $8,675.27 | $15,067.79 |