- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.46 / $2,064.41 / $2,588.98
| Professional | | $2,036.46 | $2,064.41 | $2,588.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,928.00 / $4,714.00 / $7,132.00
| Professional | | $3,928.00 | $4,714.00 | $7,132.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,831.57 / $4,128.81 / $5,646.19
| Professional | | $2,831.57 | $4,128.81 | $5,646.19 |
- 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
- $1,864.66 / $4,156.89 / $6,461.49
| Professional | | $1,864.66 | $4,156.89 | $6,461.49 |