- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,691.53 / $3,801.89
| Professional | | $2,344.23 | $2,691.53 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,964.78 / $12,882.50
| Professional | | $7,079.46 | $10,964.78 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,466.84 / $8,128.31
| Professional | | $2,754.23 | $4,466.84 | $8,128.31 |
- 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
- $2,818.38 / $4,570.88 / $9,332.54
| Professional | | $2,818.38 | $4,570.88 | $9,332.54 |