- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,917.27 / $3,017.59 / $3,682.39
| Professional | | $2,917.27 | $3,017.59 | $3,682.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,174.00 / $7,409.00 / $11,927.00
| Professional | | $6,174.00 | $7,409.00 | $11,927.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,725.47 / $5,917.28 / $7,469.38
| Professional | | $3,725.47 | $5,917.28 | $7,469.38 |
- 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
- $3,401.77 / $6,121.79 / $10,380.48
| Professional | | $3,401.77 | $6,121.79 | $10,380.48 |