- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,068.75 / $1,933.63 / $7,528.52
| Professional | | $1,068.75 | $1,933.63 | $7,528.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.41 / $1,618.41 / $1,618.41
| Facility | | $1,618.41 | $1,618.41 | $1,618.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.83 / $1,696.04 / $2,615.62
| Professional | | $989.83 | $1,696.04 | $2,615.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.05 / $1,348.83 / $2,135.31
| Facility | | $813.05 | $1,348.83 | $2,135.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,272.92 / $1,909.52 / $2,769.25
| Professional | | $1,272.92 | $1,909.52 | $2,769.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,388.52 / $2,344.36 / $2,637.85
| Professional | | $1,388.52 | $2,344.36 | $2,637.85 |