- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.25 / $2,755.13 / $4,084.64
| Professional | | $2,666.25 | $2,755.13 | $4,084.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,856.00 / $9,427.00 / $14,586.00
| Professional | | $7,856.00 | $9,427.00 | $14,586.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,086.21 / $4,982.53 / $7,166.93
| Professional | | $3,086.21 | $4,982.53 | $7,166.93 |
- 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
- $2,982.89 / $5,504.36 / $11,633.14
| Professional | | $2,982.89 | $5,504.36 | $11,633.14 |