- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,570.88 / $5,128.61
| Professional | | $3,630.78 | $4,570.88 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $380.19 / $457.09
| Professional | | $363.08 | $380.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,818.38 / $5,623.41
| Facility | | $562.34 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,630.27 / $11,481.54
| Professional | | $2,511.89 | $2,630.27 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $4,677.35
| Facility | | $3,981.07 | $3,981.07 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,511.89 / $2,884.03
| Professional | | $2,238.72 | $2,511.89 | $2,884.03 |