- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,886.12 / $2,372.98 / $2,560.26
| Professional | | $1,886.12 | $2,372.98 | $2,560.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,103.30 / $8,243.31 / $9,759.11
| Facility | | $6,103.30 | $8,243.31 | $9,759.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.64 / $284.27 / $3,794.04
| Professional | | $241.64 | $284.27 | $3,794.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.59 / $3,060.59 / $3,060.59
| Facility | | $3,060.59 | $3,060.59 | $3,060.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,234.23 / $2,234.23 / $2,234.23
| Professional | | $2,234.23 | $2,234.23 | $2,234.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.95 / $2,628.14 / $3,589.32
| Professional | | $1,889.95 | $2,628.14 | $3,589.32 |