- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,699.91 / $2,076.21 / $2,307.50
| Professional | | $1,699.91 | $2,076.21 | $2,307.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,500.78 / $7,429.52 / $8,795.68
| Facility | | $5,500.78 | $7,429.52 | $8,795.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,159.98 / $2,541.17 / $3,518.33
| Professional | | $2,159.98 | $2,541.17 | $3,518.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.07 / $2,160.07 / $2,250.39
| Facility | | $2,160.07 | $2,160.07 | $2,250.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,576.85 / $2,160.07 / $2,160.07
| Professional | | $1,576.85 | $2,160.07 | $2,160.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,754.29 / $2,221.89 / $3,234.98
| Professional | | $1,754.29 | $2,221.89 | $3,234.98 |