- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,282.56 / $2,672.78 / $3,098.40
| Professional | | $2,282.56 | $2,672.78 | $3,098.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,386.15 / $9,975.95 / $11,810.37
| Facility | | $7,386.15 | $9,975.95 | $11,810.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,412.17 / $3,412.17 / $4,724.22
| Professional | | $3,412.17 | $3,412.17 | $4,724.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,780.72 / $2,780.72 / $3,021.72
| Facility | | $2,780.72 | $2,780.72 | $3,021.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.93 / $2,780.72 / $2,780.72
| Professional | | $2,029.93 | $2,780.72 | $2,780.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,355.58 / $2,983.43 / $4,343.76
| Professional | | $2,355.58 | $2,983.43 | $4,343.76 |