- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.58 / $1,560.83 / $8,231.59
| Professional | | $1,315.58 | $1,560.83 | $8,231.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,524.37 / $2,524.37 / $2,524.37
| Facility | | $2,524.37 | $2,524.37 | $2,524.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,472.10 / $2,524.37 / $4,195.78
| Professional | | $1,472.10 | $2,524.37 | $4,195.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,556.58 / $2,140.16 / $2,861.43
| Facility | | $1,556.58 | $2,140.16 | $2,861.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,573.55 / $2,576.30 / $4,293.03
| Professional | | $1,573.55 | $2,576.30 | $4,293.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250.36 / $2,699.90 / $4,419.64
| Professional | | $2,250.36 | $2,699.90 | $4,419.64 |