- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.52 / $1,508.88 / $6,225.25
| Professional | | $1,174.52 | $1,508.88 | $6,225.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,003.15 / $1,260.32 / $1,460.45
| Professional | | $1,003.15 | $1,260.32 | $1,460.45 |
- 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
- $1,169.21 / $1,728.64 / $3,500.01
| Professional | | $1,169.21 | $1,728.64 | $3,500.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,578.41 / $2,036.15 / $3,466.44
| Professional | | $1,578.41 | $2,036.15 | $3,466.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.07 / $1,677.40 / $2,906.03
| Professional | | $1,191.07 | $1,677.40 | $2,906.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.47 / $1,815.17 / $2,233.77
| Professional | | $843.47 | $1,815.17 | $2,233.77 |