- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,974.56 / $2,035.69 / $2,680.32
| Professional | | $1,974.56 | $2,035.69 | $2,680.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,389.51 / $8,629.87 / $10,216.77
| Facility | | $6,389.51 | $8,629.87 | $10,216.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,162.92 / $2,544.61 / $4,086.77
| Professional | | $2,162.92 | $2,544.61 | $4,086.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,117.90 / $2,117.90 / $2,614.00
| Facility | | $2,117.90 | $2,117.90 | $2,614.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,546.07 / $1,546.07 / $1,546.07
| Professional | | $1,546.07 | $1,546.07 | $1,546.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,037.73 / $2,541.09 / $3,757.64
| Professional | | $2,037.73 | $2,541.09 | $3,757.64 |