- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.34 / $1,492.48 / $1,761.06
| Professional | | $1,297.34 | $1,492.48 | $1,761.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,198.10 / $5,670.08 / $6,712.71
| Facility | | $4,198.10 | $5,670.08 | $6,712.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.37 / $1,560.43 / $2,609.69
| Professional | | $1,326.37 | $1,560.43 | $2,609.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.76 / $1,552.76 / $1,717.48
| Facility | | $1,552.76 | $1,552.76 | $1,717.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.51 / $1,133.51 / $1,133.51
| Professional | | $1,133.51 | $1,133.51 | $1,133.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.85 / $1,695.71 / $2,468.88
| Professional | | $1,338.85 | $1,695.71 | $2,468.88 |