- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.41 / $2,630.02 / $3,908.44
| Professional | | $2,570.41 | $2,630.02 | $3,908.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,486.00 / $8,983.00 / $13,898.00
| Professional | | $7,486.00 | $8,983.00 | $13,898.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,934.54 / $4,751.66 / $6,802.67
| Professional | | $2,934.54 | $4,751.66 | $6,802.67 |
- 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
- $2,694.09 / $5,067.01 / $9,846.18
| Professional | | $2,694.09 | $5,067.01 | $9,846.18 |