- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,772.40 / $2,834.76 / $3,525.19
| Professional | | $2,772.40 | $2,834.76 | $3,525.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,363.00 / $6,436.00 / $9,736.00
| Professional | | $5,363.00 | $6,436.00 | $9,736.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,532.02 / $5,298.03 / $7,748.90
| Professional | | $3,532.02 | $5,298.03 | $7,748.90 |
- 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
- $3,965.07 / $5,636.31 / $9,487.37
| Professional | | $3,965.07 | $5,636.31 | $9,487.37 |