- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,245.06 / $2,487.77 / $2,882.17
| Professional | | $2,245.06 | $2,487.77 | $2,882.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $239.16 / $315.69
| Professional | | $239.16 | $239.16 | $315.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,797.14 / $3,640.63 / $4,095.71
| Facility | | $2,797.14 | $3,640.63 | $4,095.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,660.62 / $3,033.86 / $3,792.33
| Professional | | $2,660.62 | $3,033.86 | $3,792.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.69 / $3,695.30 / $8,854.41
| Professional | | $315.69 | $3,695.30 | $8,854.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.22 / $1,820.32 / $3,334.21
| Professional | | $1,274.22 | $1,820.32 | $3,334.21 |