- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,376.82 / $3,452.96 / $4,350.71
| Professional | | $3,376.82 | $3,452.96 | $4,350.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,522.00 / $7,826.00 / $11,839.00
| Professional | | $6,522.00 | $7,826.00 | $11,839.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,877.75 / $5,870.03 / $9,407.15
| Professional | | $3,877.75 | $5,870.03 | $9,407.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.00 / $6,934.00 / $26,502.00
| Facility | | $6,934.00 | $6,934.00 | $26,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,711.48 / $6,842.00 / $10,635.24
| Professional | | $3,711.48 | $6,842.00 | $10,635.24 |