- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,754.23 / $4,897.79
| Professional | | $2,454.71 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $9,120.11 / $10,964.78
| Professional | | $5,754.40 | $9,120.11 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,370.32 / $6,918.31
| Professional | | $3,388.44 | $5,370.32 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $26,915.35
| Facility | | $8,511.38 | $8,511.38 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,011.87 / $10,964.78
| Professional | | $3,090.30 | $5,011.87 | $10,964.78 |