- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,060.60 / $2,098.50 / $2,120.89
| Professional | | $2,060.60 | $2,098.50 | $2,120.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.04 / $5,011.47 / $6,926.75
| Facility | | $2,220.04 | $5,011.47 | $6,926.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.03 / $745.13 / $745.13
| Professional | | $111.03 | $745.13 | $745.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,789.64 / $1,981.08 / $3,482.61
| Facility | | $1,789.64 | $1,981.08 | $3,482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.24 / $662.88 / $963.57
| Professional | | $432.24 | $662.88 | $963.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.71 / $1,762.96 / $4,475.33
| Professional | | $490.71 | $1,762.96 | $4,475.33 |