- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.07 / $1,629.20 / $1,651.22
| Professional | | $1,453.07 | $1,629.20 | $1,651.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,585.17 / $1,761.30 / $2,395.37
| Professional | | $1,585.17 | $1,761.30 | $2,395.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.85 / $1,166.85 / $1,166.85
| Facility | | $1,166.85 | $1,166.85 | $1,166.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,529.63 / $2,529.63 / $3,162.03
| Professional | | $2,529.63 | $2,529.63 | $3,162.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,201.62 / $2,752.03 / $3,302.43
| Professional | | $2,201.62 | $2,752.03 | $3,302.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.68 / $1,100.81 / $2,003.43
| Professional | | $924.68 | $1,100.81 | $2,003.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.04 / $12.34 / $15.43
| Professional | | $12.04 | $12.34 | $15.43 |