- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,321.98 / $2,321.98 / $2,556.33
| Professional | | $2,321.98 | $2,321.98 | $2,556.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.50 / $2,491.92 / $3,082.72
| Facility | | $1,540.50 | $2,491.92 | $3,082.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.24 / $1,246.16 / $1,246.16
| Professional | | $1,059.24 | $1,246.16 | $1,246.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.74 / $5,060.64 / $5,647.54
| Facility | | $2,878.74 | $5,060.64 | $5,647.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,675.78 / $2,675.78 / $2,675.78
| Facility | | $2,675.78 | $2,675.78 | $2,675.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.05 / $1,340.28 / $1,676.67
| Professional | | $954.05 | $1,340.28 | $1,676.67 |