- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.19 / $1,177.39 / $2,175.81
| Professional | | $1,133.19 | $1,177.39 | $2,175.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.78 / $1,084.20 / $1,246.83
| Professional | | $975.78 | $1,084.20 | $1,246.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $866.25 / $1,060.51 / $1,805.59
| Professional | | $866.25 | $1,060.51 | $1,805.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,049.47 / $1,215.17 / $2,209.40
| Professional | | $1,049.47 | $1,215.17 | $2,209.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $1,236.00 / $1,236.00
| Facility | | $1,236.00 | $1,236.00 | $1,236.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.20 / $975.30 / $1,905.98
| Professional | | $726.20 | $975.30 | $1,905.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.39 / $1,104.70 / $1,207.56
| Professional | | $723.39 | $1,104.70 | $1,207.56 |