- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.07 / $1,199.78 / $5,568.44
| Professional | | $1,090.07 | $1,199.78 | $5,568.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.47 / $1,166.59 / $1,414.88
| Professional | | $1,160.47 | $1,166.59 | $1,414.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.52 / $1,745.52 / $1,745.52
| Facility | | $1,745.52 | $1,745.52 | $1,745.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.23 / $1,421.48 / $3,288.95
| Professional | | $1,059.23 | $1,421.48 | $3,288.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.19 / $1,447.29 / $2,316.54
| Professional | | $1,088.19 | $1,447.29 | $2,316.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.30 / $1,252.46 / $2,146.25
| Professional | | $924.30 | $1,252.46 | $2,146.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.79 / $1,251.42 / $1,556.13
| Professional | | $840.79 | $1,251.42 | $1,556.13 |