- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,886.09 / $3,953.00 / $4,945.78
| Professional | | $3,886.09 | $3,953.00 | $4,945.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,511.00 / $9,013.00 / $13,636.00
| Professional | | $7,511.00 | $9,013.00 | $13,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,422.83 / $7,906.01 / $10,782.49
| Professional | | $5,422.83 | $7,906.01 | $10,782.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,509.00 / $8,509.00 / $27,952.00
| Facility | | $8,509.00 | $8,509.00 | $27,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,611.47 / $7,976.65 / $14,323.40
| Professional | | $5,611.47 | $7,976.65 | $14,323.40 |