- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,763.79 / $2,177.48 / $11,494.70
| Professional | | $1,763.79 | $2,177.48 | $11,494.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,421.91 / $3,421.91 / $3,421.91
| Facility | | $3,421.91 | $3,421.91 | $3,421.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,073.84 / $3,046.74 / $5,999.31
| Professional | | $2,073.84 | $3,046.74 | $5,999.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,955.00 / $2,891.73 / $4,094.81
| Facility | | $1,955.00 | $2,891.73 | $4,094.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,207.05 / $3,496.17 / $5,825.87
| Professional | | $2,207.05 | $3,496.17 | $5,825.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,960.04 / $3,680.42 / $4,502.54
| Professional | | $2,960.04 | $3,680.42 | $4,502.54 |