- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,615.38 / $2,653.55 / $3,325.22
| Professional | | $2,615.38 | $2,653.55 | $3,325.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,046.00 / $6,055.00 / $9,161.00
| Professional | | $5,046.00 | $6,055.00 | $9,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,634.72 / $5,307.10 / $7,255.12
| Professional | | $3,634.72 | $5,307.10 | $7,255.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.00 / $6,934.00 / $26,502.00
| Facility | | $6,934.00 | $6,934.00 | $26,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,108.42 / $5,329.85 / $9,118.20
| Professional | | $3,108.42 | $5,329.85 | $9,118.20 |