- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.98 / $2,321.98 / $2,554.17
| Professional | | $2,321.98 | $2,321.98 | $2,554.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,915.70 / $2,409.32 / $7,279.66
| Facility | | $1,915.70 | $2,409.32 | $7,279.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,915.70 / $2,409.32 / $7,279.66
| Facility | | $1,915.70 | $2,409.32 | $7,279.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.49 / $1,456.87 / $1,800.93
| Professional | | $1,080.49 | $1,456.87 | $1,800.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,392.88 / $1,442.05 / $2,026.00
| Professional | | $1,392.88 | $1,442.05 | $2,026.00 |