- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.24 / $1,506.47 / $2,082.48
| Professional | | $1,329.24 | $1,506.47 | $2,082.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.46 / $930.46 / $2,658.59
| Professional | | $930.46 | $930.46 | $2,658.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,713.31 / $2,713.31 / $3,212.33
| Professional | | $2,713.31 | $2,713.31 | $3,212.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,683.70 / $2,215.40 / $3,101.56
| Facility | | $1,683.70 | $2,215.40 | $3,101.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.32 / $3,035.10 / $3,876.95
| Professional | | $1,772.32 | $3,035.10 | $3,876.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.47 / $930.47 / $1,329.24
| Professional | | $930.47 | $930.47 | $1,329.24 |