- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,166.79 / $2,453.77 / $2,708.49
| Professional | | $2,166.79 | $2,453.77 | $2,708.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.17 / $1,988.74 / $3,263.58
| Facility | | $265.17 | $1,988.74 | $3,263.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.57 / $2,141.71 / $3,004.61
| Professional | | $285.57 | $2,141.71 | $3,004.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,672.64 / $2,672.64 / $4,752.78
| Facility | | $2,672.64 | $2,672.64 | $4,752.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,672.64 / $2,672.64 / $19,750.18
| Professional | | $2,672.64 | $2,672.64 | $19,750.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,553.41 / $2,290.17 / $3,671.60
| Professional | | $1,553.41 | $2,290.17 | $3,671.60 |