- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,603.46 / $2,685.69 / $3,534.01
| Professional | | $2,603.46 | $2,685.69 | $3,534.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,424.57 / $11,378.49 / $13,470.80
| Facility | | $8,424.57 | $11,378.49 | $13,470.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,661.69 / $3,131.40 / $5,237.03
| Professional | | $2,661.69 | $3,131.40 | $5,237.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,446.55 / $3,813.78 / $3,813.78
| Facility | | $3,446.55 | $3,813.78 | $3,813.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,784.06 / $3,813.78 / $3,813.78
| Professional | | $2,784.06 | $3,813.78 | $3,813.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,327.57 / $3,350.43 / $4,954.43
| Professional | | $2,327.57 | $3,350.43 | $4,954.43 |