- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,548.82 / $4,168.69
| Professional | | $1,513.56 | $1,548.82 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,623.41 / $6,760.83
| Professional | | $3,467.37 | $5,623.41 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,818.38 / $3,715.35
| Professional | | $2,137.96 | $2,818.38 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $3,090.30
| Facility | | $1,288.25 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,388.44 / $5,754.40
| Professional | | $1,819.70 | $3,388.44 | $5,754.40 |