- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.36 / $2,267.39 / $2,459.21
| Professional | | $1,670.36 | $2,267.39 | $2,459.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,405.16 / $7,300.36 / $8,642.77
| Facility | | $5,405.16 | $7,300.36 | $8,642.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,009.08 / $2,009.08 / $3,360.04
| Professional | | $2,009.08 | $2,009.08 | $3,360.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,297.39 / $3,297.39 / $3,297.39
| Facility | | $3,297.39 | $3,297.39 | $3,297.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,407.09 / $3,297.39 / $3,297.39
| Professional | | $2,407.09 | $3,297.39 | $3,297.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,097.31 / $5,097.31 / $5,097.31
| Facility | | $5,097.31 | $5,097.31 | $5,097.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,723.80 / $2,542.98 / $3,178.74
| Professional | | $1,723.80 | $2,542.98 | $3,178.74 |