- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,267.55 / $1,490.56 / $7,858.19
| Professional | | $1,267.55 | $1,490.56 | $7,858.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,406.59 / $2,406.59 / $2,406.59
| Facility | | $2,406.59 | $2,406.59 | $2,406.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,427.19 / $2,406.07 / $4,339.49
| Professional | | $1,427.19 | $2,406.07 | $4,339.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.61 / $1,987.72 / $2,748.85
| Facility | | $1,408.61 | $1,987.72 | $2,748.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.55 / $2,457.13 / $4,094.46
| Professional | | $1,506.55 | $2,457.13 | $4,094.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,091.96 / $2,555.51 / $4,214.29
| Professional | | $2,091.96 | $2,555.51 | $4,214.29 |