- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,366.08 / $4,453.39 / $4,490.32
| Professional | | $3,366.08 | $4,453.39 | $4,490.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,405.01 / $4,316.60 / $4,316.60
| Professional | | $3,405.01 | $4,316.60 | $4,316.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,282.89 / $3,282.89 / $3,282.89
| Facility | | $3,282.89 | $3,282.89 | $3,282.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,790.46 / $3,282.89 / $3,282.89
| Professional | | $2,790.46 | $3,282.89 | $3,282.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,895.24 / $3,895.24 / $3,895.24
| Professional | | $3,895.24 | $3,895.24 | $3,895.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,199.71 / $3,100.02 / $5,056.17
| Professional | | $2,199.71 | $3,100.02 | $5,056.17 |