- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.49 / $1,347.09 / $7,102.53
| Professional | | $1,144.49 | $1,347.09 | $7,102.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,167.87 / $2,167.87 / $2,167.87
| Facility | | $2,167.87 | $2,167.87 | $2,167.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.75 / $2,166.52 / $3,918.39
| Professional | | $1,283.75 | $2,166.52 | $3,918.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.28 / $1,796.37 / $2,485.73
| Facility | | $1,335.28 | $1,796.37 | $2,485.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,362.14 / $2,217.19 / $3,694.63
| Professional | | $1,362.14 | $2,217.19 | $3,694.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,889.39 / $2,307.84 / $2,901.60
| Professional | | $1,889.39 | $2,307.84 | $2,901.60 |