- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,492.85 / $1,738.10 / $2,026.44
| Professional | | $1,492.85 | $1,738.10 | $2,026.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,830.74 / $6,524.55 / $7,724.30
| Facility | | $4,830.74 | $6,524.55 | $7,724.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,526.24 / $1,795.58 / $3,002.97
| Professional | | $1,526.24 | $1,795.58 | $3,002.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,808.29 / $1,808.29 / $1,808.29
| Facility | | $1,808.29 | $1,808.29 | $1,808.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,537.05 / $1,537.05 / $1,537.05
| Professional | | $1,537.05 | $1,537.05 | $1,537.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,472.69 / $1,951.25 / $2,840.93
| Professional | | $1,472.69 | $1,951.25 | $2,840.93 |