- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.50 / $1,774.62 / $9,354.87
| Professional | | $1,506.50 | $1,774.62 | $9,354.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,860.35 / $2,860.35 / $2,860.35
| Facility | | $2,860.35 | $2,860.35 | $2,860.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,679.84 / $2,857.62 / $5,185.42
| Professional | | $1,679.84 | $2,857.62 | $5,185.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.44 / $2,365.90 / $3,266.86
| Facility | | $1,763.44 | $2,365.90 | $3,266.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,795.47 / $2,923.00 / $4,870.77
| Professional | | $1,795.47 | $2,923.00 | $4,870.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,492.40 / $3,034.87 / $3,827.66
| Professional | | $2,492.40 | $3,034.87 | $3,827.66 |