- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,644.37 / $2,974.48 / $5,319.86
| Professional | | $2,644.37 | $2,974.48 | $5,319.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,386.40 / $3,386.40 / $4,146.67
| Professional | | $3,386.40 | $3,386.40 | $4,146.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,790.37 / $3,790.37 / $3,790.37
| Facility | | $3,790.37 | $3,790.37 | $3,790.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,766.97 / $2,766.97 / $3,790.37
| Professional | | $2,766.97 | $2,766.97 | $3,790.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,246.18 / $6,065.98 / $8,735.01
| Professional | | $4,246.18 | $6,065.98 | $8,735.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,732.44 / $3,166.90 / $4,798.81
| Professional | | $2,732.44 | $3,166.90 | $4,798.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,670.57 / $3,670.57 / $4,246.18
| Professional | | $3,670.57 | $3,670.57 | $4,246.18 |