- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,678.65 / $3,372.21
| Professional | | $2,663.12 | $2,678.65 | $3,372.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,116.00 / $6,139.00 / $9,288.00
| Professional | | $5,116.00 | $6,139.00 | $9,288.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,742.68 / $4,553.70 / $7,379.01
| Professional | | $2,742.68 | $4,553.70 | $7,379.01 |
- 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
- $3,080.47 / $5,021.25 / $8,963.50
| Professional | | $3,080.47 | $5,021.25 | $8,963.50 |