- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,066.66 / $3,205.32 / $4,162.76
| Professional | | $3,066.66 | $3,205.32 | $4,162.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,923.44 / $13,402.91 / $15,867.47
| Facility | | $9,923.44 | $13,402.91 | $15,867.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,135.24 / $3,688.52 / $6,168.78
| Professional | | $3,135.24 | $3,688.52 | $6,168.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,059.73 / $4,072.36 / $4,072.36
| Facility | | $4,059.73 | $4,072.36 | $4,072.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,972.82 / $4,072.36 / $4,072.36
| Professional | | $2,972.82 | $4,072.36 | $4,072.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,164.75 / $4,006.65 / $5,835.92
| Professional | | $3,164.75 | $4,006.65 | $5,835.92 |