- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,019.95 / $6,456.54
| Professional | | $2,630.27 | $3,019.95 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,918.31 / $8,317.64
| Professional | | $6,165.95 | $6,918.31 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,801.89 / $6,456.54
| Professional | | $2,754.23 | $3,801.89 | $6,456.54 |
- 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
- $2,344.23 / $5,128.61 / $8,912.51
| Professional | | $2,344.23 | $5,128.61 | $8,912.51 |