- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.80 / $1,367.87 / $1,801.03
| Professional | | $1,326.80 | $1,367.87 | $1,801.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,293.42 / $5,798.81 / $6,865.11
| Facility | | $4,293.42 | $5,798.81 | $6,865.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,685.91 / $1,983.42 / $2,746.10
| Professional | | $1,685.91 | $1,983.42 | $2,746.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,654.54 / $1,654.54 / $1,756.46
| Facility | | $1,654.54 | $1,654.54 | $1,756.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.81 / $1,654.54 / $1,654.54
| Professional | | $1,207.81 | $1,654.54 | $1,654.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,369.24 / $1,709.84 / $2,524.92
| Professional | | $1,369.24 | $1,709.84 | $2,524.92 |