- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,104.81 / $4,214.55 / $4,226.82
| Professional | | $3,104.81 | $4,214.55 | $4,226.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,046.90 / $13,569.67 / $16,064.90
| Facility | | $10,046.90 | $13,569.67 | $16,064.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,174.25 / $3,734.41 / $6,245.53
| Professional | | $3,174.25 | $3,734.41 | $6,245.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,110.22 / $4,697.47 / $4,697.47
| Facility | | $4,110.22 | $4,697.47 | $4,697.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,429.16 / $3,429.16 / $3,429.16
| Professional | | $3,429.16 | $3,429.16 | $3,429.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,775.79 / $4,529.51 / $5,908.53
| Professional | | $2,775.79 | $4,529.51 | $5,908.53 |