- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,798.34 / $1,833.18 / $2,278.40
| Professional | | $1,798.34 | $1,833.18 | $2,278.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,530.00 / $4,236.00 / $6,408.00
| Professional | | $3,530.00 | $4,236.00 | $6,408.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,468.19 / $3,599.28 / $5,021.02
| Professional | | $2,468.19 | $3,599.28 | $5,021.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,509.00 / $8,509.00 / $27,952.00
| Facility | | $8,509.00 | $8,509.00 | $27,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,604.34 / $3,740.41 / $6,310.19
| Professional | | $2,604.34 | $3,740.41 | $6,310.19 |