- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,818.38 / $3,801.89
| Professional | | $2,511.89 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $11,481.54 / $13,803.84
| Professional | | $7,413.10 | $11,481.54 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,677.35 / $8,709.64
| Professional | | $2,884.03 | $4,677.35 | $8,709.64 |
- 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
- $2,951.21 / $4,786.30 / $9,772.37
| Professional | | $2,951.21 | $4,786.30 | $9,772.37 |