- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,822.43 / $2,412.52 / $2,466.60
| Professional | | $1,822.43 | $2,412.52 | $2,466.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.05 / $2,279.06 / $2,279.06
| Professional | | $1,936.05 | $2,279.06 | $2,279.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.76 / $1,406.76 / $1,406.76
| Facility | | $1,406.76 | $1,406.76 | $1,406.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,195.75 / $1,406.76 / $1,406.76
| Professional | | $1,195.75 | $1,406.76 | $1,406.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.58 / $1,772.58 / $1,772.58
| Professional | | $1,772.58 | $1,772.58 | $1,772.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $988.77 / $1,427.98 / $1,919.21
| Professional | | $988.77 | $1,427.98 | $1,919.21 |