- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,663.80 / $1,715.30 / $2,258.48
| Professional | | $1,663.80 | $1,715.30 | $2,258.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,383.91 / $7,271.69 / $8,608.84
| Facility | | $5,383.91 | $7,271.69 | $8,608.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,701.01 / $2,001.19 / $3,346.85
| Professional | | $1,701.01 | $2,001.19 | $3,346.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.41 / $2,050.41 / $2,202.60
| Facility | | $2,050.41 | $2,050.41 | $2,202.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,496.80 / $1,496.80 / $1,496.80
| Professional | | $1,496.80 | $1,496.80 | $1,496.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,717.02 / $2,141.16 / $3,166.25
| Professional | | $1,717.02 | $2,141.16 | $3,166.25 |