- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.01 / $1,131.01 / $1,379.82
| Professional | | $891.01 | $1,131.01 | $1,379.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.48 / $930.60 / $1,284.22
| Professional | | $778.48 | $930.60 | $1,284.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.06 / $1,282.86 / $1,496.68
| Facility | | $1,069.06 | $1,282.86 | $1,496.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.06 / $1,229.42 / $1,550.14
| Professional | | $1,069.06 | $1,229.42 | $1,550.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.88 / $1,336.88 / $1,336.88
| Facility | | $1,336.88 | $1,336.88 | $1,336.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.13 / $1,247.86 / $1,930.45
| Professional | | $945.13 | $1,247.86 | $1,930.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.09 / $986.56 / $1,442.43
| Professional | | $801.09 | $986.56 | $1,442.43 |