- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,520.16 / $2,520.16 / $4,202.18
| Professional | | $2,520.16 | $2,520.16 | $4,202.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.43 / $4,700.77 / $8,713.75
| Facility | | $3,964.43 | $4,700.77 | $8,713.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,257.26 / $2,257.26 / $3,129.41
| Professional | | $2,257.26 | $2,257.26 | $3,129.41 |
- 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 / $3,206.26
| Professional | | $2,271.73 | $2,672.64 | $3,206.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,259.95 / $3,259.95 / $3,259.95
| Professional | | $3,259.95 | $3,259.95 | $3,259.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,858.91 / $2,520.16 / $4,202.18
| Professional | | $1,858.91 | $2,520.16 | $4,202.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,364.85 / $2,047.28 / $4,250.47
| Professional | | $1,364.85 | $2,047.28 | $4,250.47 |