- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,660.81 / $2,560.04 / $2,560.04
| Professional | | $1,660.81 | $2,560.04 | $2,560.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,380.70 / $4,380.01 / $8,119.15
| Facility | | $3,380.70 | $4,380.01 | $8,119.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,970.30 / $2,054.92 / $2,853.69
| Professional | | $1,970.30 | $2,054.92 | $2,853.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.21 / $2,861.13 / $2,861.13
| Facility | | $1,802.21 | $2,861.13 | $2,861.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,431.96 / $2,431.96 / $2,861.13
| Professional | | $2,431.96 | $2,431.96 | $2,861.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,077.57 / $3,077.57 / $3,077.57
| Professional | | $3,077.57 | $3,077.57 | $3,077.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,140.27 / $2,560.04 / $2,560.04
| Professional | | $2,140.27 | $2,560.04 | $2,560.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.22 / $2,118.48 / $4,360.97
| Professional | | $1,264.22 | $2,118.48 | $4,360.97 |