- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,557.92 / $2,614.34 / $3,254.73
| Professional | | $2,557.92 | $2,614.34 | $3,254.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,946.00 / $5,935.00 / $8,978.00
| Professional | | $4,946.00 | $5,935.00 | $8,978.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,254.73 / $4,882.09 / $7,149.30
| Professional | | $3,254.73 | $4,882.09 | $7,149.30 |
- 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
- $3,225.89 / $5,195.41 / $9,262.46
| Professional | | $3,225.89 | $5,195.41 | $9,262.46 |