- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,505.37 / $2,578.40 / $14,985.30
| Professional | | $1,505.37 | $2,578.40 | $14,985.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,863.00 / $6,246.00 / $7,495.00
| Professional | | $3,863.00 | $6,246.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.62 / $2,312.21 / $3,468.31
| Professional | | $1,778.62 | $2,312.21 | $3,468.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,188.00 / $5,188.00 / $18,767.00
| Facility | | $5,188.00 | $5,188.00 | $18,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,747.95 / $2,636.36 / $5,723.88
| Professional | | $1,747.95 | $2,636.36 | $5,723.88 |