- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,264.15 / $1,545.40 / $6,731.81
| Professional | | $1,264.15 | $1,545.40 | $6,731.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.00 / $1,427.72 / $1,580.35
| Professional | | $1,190.00 | $1,427.72 | $1,580.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,076.35 / $3,076.35 / $3,076.35
| Facility | | $3,076.35 | $3,076.35 | $3,076.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.53 / $1,649.26 / $3,340.60
| Professional | | $1,103.53 | $1,649.26 | $3,340.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.74 / $1,719.23 / $2,952.78
| Professional | | $1,332.74 | $1,719.23 | $2,952.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.18 / $1,449.12 / $2,547.67
| Professional | | $1,047.18 | $1,449.12 | $2,547.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.51 / $1,532.65 / $1,893.09
| Professional | | $998.51 | $1,532.65 | $1,893.09 |