- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,269.92 / $1,381.84 / $7,161.54
| Professional | | $1,269.92 | $1,381.84 | $7,161.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,186.28 / $2,186.28 / $2,186.28
| Facility | | $2,186.28 | $2,186.28 | $2,186.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,364.76 / $2,175.15 / $4,031.28
| Professional | | $1,364.76 | $2,175.15 | $4,031.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.28 / $1,939.22 / $2,743.79
| Facility | | $1,345.28 | $1,939.22 | $2,743.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,446.86 / $2,225.82 / $3,709.01
| Professional | | $1,446.86 | $2,225.82 | $3,709.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,970.85 / $2,391.27 / $2,925.42
| Professional | | $1,970.85 | $2,391.27 | $2,925.42 |