- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.30 / $1,210.79 / $1,541.92
| Professional | | $900.30 | $1,210.79 | $1,541.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $778.48 / $1,072.21 / $1,803.65
| Professional | | $778.48 | $1,072.21 | $1,803.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.46 / $1,320.18 / $2,292.25
| Professional | | $967.46 | $1,320.18 | $2,292.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.17 / $1,432.42 / $2,793.22
| Facility | | $1,070.17 | $1,432.42 | $2,793.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.18 / $1,283.89 / $8,114.99
| Professional | | $878.18 | $1,283.89 | $8,114.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.98 / $1,136.34 / $1,965.90
| Professional | | $815.98 | $1,136.34 | $1,965.90 |