- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,239.02 / $2,934.43 / $3,343.89
| Professional | | $2,239.02 | $2,934.43 | $3,343.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,326.92 / $2,529.27 / $2,529.27
| Professional | | $2,326.92 | $2,529.27 | $2,529.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,672.64 / $2,672.64 / $3,407.14
| Facility | | $2,672.64 | $2,672.64 | $3,407.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.73 / $2,672.64 / $4,729.50
| Professional | | $2,271.73 | $2,672.64 | $4,729.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,364.85 / $2,044.89 / $3,241.52
| Professional | | $1,364.85 | $2,044.89 | $3,241.52 |