- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.01 / $1,186.66 / $1,214.59
| Professional | | $1,008.01 | $1,186.66 | $1,214.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.24 / $1,307.36 / $1,989.18
| Professional | | $1,010.24 | $1,307.36 | $1,989.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.00 / $982.00 / $1,084.92
| Facility | | $982.00 | $982.00 | $1,084.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.58 / $1,257.29 / $2,085.69
| Professional | | $860.58 | $1,257.29 | $2,085.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.05 / $1,389.73 / $2,174.67
| Professional | | $1,079.05 | $1,389.73 | $2,174.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.01 / $1,186.66 / $2,300.08
| Professional | | $1,008.01 | $1,186.66 | $2,300.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.49 / $1,267.45 / $2,083.05
| Professional | | $941.49 | $1,267.45 | $2,083.05 |