- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,416.19 / $2,483.79 / $3,102.23
| Professional | | $2,416.19 | $2,483.79 | $3,102.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,661.00 / $5,593.00 / $8,461.00
| Professional | | $4,661.00 | $5,593.00 | $8,461.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,427.63 / $4,967.59 / $6,728.34
| Professional | | $3,427.63 | $4,967.59 | $6,728.34 |
- 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
- $2,916.10 / $4,900.34 / $8,797.09
| Professional | | $2,916.10 | $4,900.34 | $8,797.09 |