- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,821.87 / $2,860.56 / $3,585.48
| Professional | | $2,821.87 | $2,860.56 | $3,585.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,443.00 / $6,532.00 / $9,882.00
| Professional | | $5,443.00 | $6,532.00 | $9,882.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,921.12 / $5,721.12 / $7,824.52
| Professional | | $3,921.12 | $5,721.12 | $7,824.52 |
- 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
- $3,257.16 / $5,758.21 / $9,831.90
| Professional | | $3,257.16 | $5,758.21 | $9,831.90 |