- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,645.02 / $2,733.07 / $3,338.29
| Professional | | $2,645.02 | $2,733.07 | $3,338.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,595.00 / $6,714.00 / $10,807.00
| Professional | | $5,595.00 | $6,714.00 | $10,807.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,359.14 / $5,349.95 / $6,772.90
| Professional | | $3,359.14 | $5,349.95 | $6,772.90 |
- 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
- $3,060.10 / $5,531.15 / $9,361.29
| Professional | | $3,060.10 | $5,531.15 | $9,361.29 |