- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.33 / $1,732.93 / $1,974.15
| Professional | | $1,454.33 | $1,732.93 | $1,974.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,706.07 / $6,356.19 / $7,524.98
| Facility | | $4,706.07 | $6,356.19 | $7,524.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,847.95 / $2,174.06 / $3,010.05
| Professional | | $1,847.95 | $2,174.06 | $3,010.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.28 / $2,289.62 / $2,289.62
| Facility | | $1,925.28 | $2,289.62 | $2,289.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.42 / $1,671.42 / $1,671.42
| Professional | | $1,671.42 | $1,671.42 | $1,671.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.85 / $1,900.90 / $2,767.62
| Professional | | $1,500.85 | $1,900.90 | $2,767.62 |