- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,533.87 / $7,001.33 / $7,852.66
| Professional | | $1,533.87 | $7,001.33 | $7,852.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,470.00 / $1,536.59 / $1,690.25
| Professional | | $1,470.00 | $1,536.59 | $1,690.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,573.03 / $5,506.05 / $6,596.87
| Professional | | $4,573.03 | $5,506.05 | $6,596.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.32 / $1,822.29 / $2,366.85
| Professional | | $1,405.32 | $1,822.29 | $2,366.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,522.00 / $3,522.00 / $3,522.00
| Facility | | $3,522.00 | $3,522.00 | $3,522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,049.01 / $1,481.95 / $2,887.64
| Professional | | $1,049.01 | $1,481.95 | $2,887.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,279.14 / $1,624.52 / $1,994.43
| Professional | | $1,279.14 | $1,624.52 | $1,994.43 |