- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,282.29 / $2,319.31 / $2,912.55
| Professional | | $2,282.29 | $2,319.31 | $2,912.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,388.00 / $5,266.00 / $7,966.00
| Professional | | $4,388.00 | $5,266.00 | $7,966.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,007.20 / $4,510.80 / $6,328.10
| Professional | | $3,007.20 | $4,510.80 | $6,328.10 |
- 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
- $2,539.15 / $4,323.79 / $7,976.79
| Professional | | $2,539.15 | $4,323.79 | $7,976.79 |