- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,735.32 / $3,462.38 / $18,194.59
| Professional | | $2,735.32 | $3,462.38 | $18,194.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,566.12 / $5,566.12 / $5,566.12
| Facility | | $5,566.12 | $5,566.12 | $5,566.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,253.30 / $5,566.12 / $10,045.70
| Professional | | $3,253.30 | $5,566.12 | $10,045.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,964.97 / $4,443.93 / $6,127.03
| Facility | | $2,964.97 | $4,443.93 | $6,127.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,477.31 / $5,686.94 / $9,476.48
| Professional | | $3,477.31 | $5,686.94 | $9,476.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,843.80 / $5,771.34 / $7,727.78
| Professional | | $4,843.80 | $5,771.34 | $7,727.78 |