- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,240.48 / $1,447.17 / $7,629.91
| Professional | | $1,240.48 | $1,447.17 | $7,629.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,336.13 / $2,336.13 / $2,336.13
| Facility | | $2,336.13 | $2,336.13 | $2,336.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.92 / $2,265.14 / $3,694.52
| Professional | | $1,342.92 | $2,265.14 | $3,694.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.69 / $1,949.82 / $2,600.84
| Facility | | $1,377.69 | $1,949.82 | $2,600.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.67 / $2,385.42 / $3,974.96
| Professional | | $1,456.67 | $2,385.42 | $3,974.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,030.86 / $2,503.04 / $3,118.86
| Professional | | $2,030.86 | $2,503.04 | $3,118.86 |