- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,490.47 / $1,752.30 / $9,237.35
| Professional | | $1,490.47 | $1,752.30 | $9,237.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,821.44 / $2,821.44 / $2,821.44
| Facility | | $2,821.44 | $2,821.44 | $2,821.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.20 / $2,817.79 / $5,102.93
| Professional | | $1,657.20 | $2,817.79 | $5,102.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,738.94 / $2,359.02 / $3,227.02
| Facility | | $1,738.94 | $2,359.02 | $3,227.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,771.26 / $2,884.72 / $4,806.97
| Professional | | $1,771.26 | $2,884.72 | $4,806.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.34 / $2,218.34 / $2,218.34
| Facility | | $2,218.34 | $2,218.34 | $2,218.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,460.91 / $3,000.31 / $4,502.96
| Professional | | $2,460.91 | $3,000.31 | $4,502.96 |