- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.39 / $1,451.12 / $7,568.80
| Professional | | $1,336.39 | $1,451.12 | $7,568.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,307.73 / $2,307.73 / $2,307.73
| Facility | | $2,307.73 | $2,307.73 | $2,307.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,433.25 / $2,294.63 / $4,282.10
| Professional | | $1,433.25 | $2,294.63 | $4,282.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.64 / $2,126.33 / $2,813.99
| Facility | | $1,419.64 | $2,126.33 | $2,813.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,521.99 / $2,354.15 / $3,922.85
| Professional | | $1,521.99 | $2,354.15 | $3,922.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,045.39 / $2,512.80 / $3,097.94
| Professional | | $2,045.39 | $2,512.80 | $3,097.94 |