- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,698.24 / $5,128.61
| Professional | | $1,659.59 | $1,698.24 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $6,165.95 / $7,413.10
| Professional | | $3,890.45 | $6,165.95 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,162.28 / $4,570.88
| Professional | | $2,454.71 | $3,162.28 | $4,570.88 |
- 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
- $2,089.30 / $3,715.35 / $6,456.54
| Professional | | $2,089.30 | $3,715.35 | $6,456.54 |