- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,852.12 / $2,951.41 / $3,600.14
| Professional | | $2,852.12 | $2,951.41 | $3,600.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,039.00 / $7,247.00 / $11,665.00
| Professional | | $6,039.00 | $7,247.00 | $11,665.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,637.86 / $5,790.75 / $7,302.70
| Professional | | $3,637.86 | $5,790.75 | $7,302.70 |
- 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
- $3,428.05 / $5,817.71 / $10,128.29
| Professional | | $3,428.05 | $5,817.71 | $10,128.29 |