- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,105.48 / $2,649.64 / $2,858.04
| Professional | | $2,105.48 | $2,649.64 | $2,858.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,813.16 / $9,202.04 / $10,894.14
| Facility | | $6,813.16 | $9,202.04 | $10,894.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,675.34 / $3,147.46 / $4,357.72
| Professional | | $2,675.34 | $3,147.46 | $4,357.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,756.64 / $2,756.64 / $2,756.64
| Facility | | $2,756.64 | $2,756.64 | $2,756.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,012.35 / $2,012.35 / $2,012.35
| Professional | | $2,012.35 | $2,012.35 | $2,012.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,882.36 / $2,567.73 / $4,006.78
| Professional | | $1,882.36 | $2,567.73 | $4,006.78 |