- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,031.13 / $2,052.46 / $2,584.21
| Professional | | $2,031.13 | $2,052.46 | $2,584.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,894.00 / $4,673.00 / $7,069.00
| Professional | | $3,894.00 | $4,673.00 | $7,069.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,782.68 / $4,104.93 / $5,628.00
| Professional | | $2,782.68 | $4,104.93 | $5,628.00 |
- 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
- $2,286.85 / $4,124.85 / $6,954.99
| Professional | | $2,286.85 | $4,124.85 | $6,954.99 |