- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,403.82 / $1,617.48 / $6,776.34
| Professional | | $1,403.82 | $1,617.48 | $6,776.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.85 / $2,034.85 / $2,418.75
| Facility | | $2,034.85 | $2,034.85 | $2,418.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.35 / $2,034.85 / $2,911.62
| Professional | | $1,297.35 | $2,034.85 | $2,911.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.85 / $2,514.19 / $2,570.48
| Facility | | $2,034.85 | $2,514.19 | $2,570.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,781.41 / $2,852.67
| Professional | | $1,257.44 | $1,781.41 | $2,852.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,972.68 / $2,273.27 / $2,697.10
| Professional | | $1,972.68 | $2,273.27 | $2,697.10 |