- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.96 / $2,405.52 / $2,595.35
| Professional | | $1,911.96 | $2,405.52 | $2,595.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,186.93 / $8,356.24 / $9,892.81
| Facility | | $6,186.93 | $8,356.24 | $9,892.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,094.35 / $2,463.94 / $3,957.19
| Professional | | $2,094.35 | $2,463.94 | $3,957.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,502.67 / $2,502.67 / $2,528.88
| Facility | | $2,502.67 | $2,502.67 | $2,528.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,826.95 / $2,502.67 / $2,502.67
| Professional | | $1,826.95 | $2,502.67 | $2,502.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,998.13 / $2,664.18 / $3,638.49
| Professional | | $1,998.13 | $2,664.18 | $3,638.49 |