- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.09 / $1,434.04 / $1,451.31
| Professional | | $1,029.09 | $1,434.04 | $1,451.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.45 / $1,617.00 / $2,326.23
| Professional | | $1,374.45 | $1,617.00 | $2,326.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $1,683.04 / $2,713.56
| Professional | | $150.00 | $1,683.04 | $2,713.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,649.00 / $4,915.00 / $7,205.00
| Facility | | $1,649.00 | $4,915.00 | $7,205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,113.96 / $1,530.15 / $2,256.59
| Professional | | $1,113.96 | $1,530.15 | $2,256.59 |