- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,290.87 / $2,818.38
| Professional | | $2,041.74 | $2,290.87 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,760.83 / $6,918.31
| Professional | | $4,570.88 | $6,760.83 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $4,365.16
| Professional | | $3,467.37 | $3,467.37 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,187.76 / $2,884.03
| Facility | | $1,819.70 | $2,187.76 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,365.16 / $15,135.61
| Professional | | $3,801.89 | $4,365.16 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,801.89 / $4,677.35
| Professional | | $1,288.25 | $3,801.89 | $4,677.35 |