- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.15 / $2,399.53 / $9,259.36
| Professional | | $1,386.15 | $2,399.53 | $9,259.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,067.44 / $2,067.44 / $2,611.65
| Professional | | $2,067.44 | $2,067.44 | $2,611.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,067.44 / $2,067.44 / $2,067.44
| Facility | | $2,067.44 | $2,067.44 | $2,067.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.93 / $2,219.90 / $3,168.41
| Professional | | $1,279.93 | $2,219.90 | $3,168.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.30 / $1,642.46 / $2,657.19
| Facility | | $1,036.30 | $1,642.46 | $2,657.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.67 / $2,388.65 / $3,406.56
| Professional | | $1,543.67 | $2,388.65 | $3,406.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,414.85 / $2,940.57 / $3,189.76
| Professional | | $2,414.85 | $2,940.57 | $3,189.76 |