- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,162.28 / $6,918.31
| Professional | | $2,818.38 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,413.10 / $8,912.51
| Professional | | $6,456.54 | $7,413.10 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,073.80 / $6,760.83
| Professional | | $3,981.07 | $4,073.80 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $3,090.30
| Facility | | $1,288.25 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,495.41 / $10,715.19
| Professional | | $3,311.31 | $5,495.41 | $10,715.19 |