- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,445.44 / $3,890.45
| Professional | | $1,412.54 | $1,445.44 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $6,309.57
| Professional | | $3,235.94 | $5,248.07 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,630.27 / $3,801.89
| Professional | | $1,949.84 | $2,630.27 | $3,801.89 |
- 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
- $1,548.82 / $3,162.28 / $5,248.07
| Professional | | $1,548.82 | $3,162.28 | $5,248.07 |