- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,270.71 / $1,489.47 / $7,454.66
| Professional | | $1,270.71 | $1,489.47 | $7,454.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,278.82 / $2,278.82 / $2,278.82
| Facility | | $2,278.82 | $2,278.82 | $2,278.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.35 / $2,275.16 / $4,174.46
| Professional | | $1,401.35 | $2,275.16 | $4,174.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.68 / $1,887.70 / $2,778.57
| Facility | | $1,082.68 | $1,887.70 | $2,778.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.80 / $2,318.02 / $3,862.65
| Professional | | $1,506.80 | $2,318.02 | $3,862.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,006.22 / $2,484.48 / $2,947.70
| Professional | | $2,006.22 | $2,484.48 | $2,947.70 |