- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,820.29 / $2,194.12 / $2,470.91
| Professional | | $1,820.29 | $2,194.12 | $2,470.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,890.30 / $7,955.63 / $9,418.53
| Facility | | $5,890.30 | $7,955.63 | $9,418.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,312.96 / $2,721.13 / $3,767.47
| Professional | | $2,312.96 | $2,721.13 | $3,767.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,282.71 / $2,282.71 / $2,407.63
| Facility | | $2,282.71 | $2,282.71 | $2,407.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,666.39 / $1,666.39 / $1,666.39
| Professional | | $1,666.39 | $1,666.39 | $1,666.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,878.52 / $2,430.05 / $3,464.05
| Professional | | $1,878.52 | $2,430.05 | $3,464.05 |