- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.42 / $1,614.82 / $2,194.80
| Professional | | $1,315.42 | $1,614.82 | $2,194.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,055.73 / $2,055.73 / $2,150.46
| Professional | | $2,055.73 | $2,055.73 | $2,150.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.09 / $1,850.09 / $1,850.09
| Facility | | $1,850.09 | $1,850.09 | $1,850.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,572.58 / $1,572.58 / $1,572.58
| Professional | | $1,572.58 | $1,572.58 | $1,572.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,944.31 / $3,436.55 / $4,352.25
| Professional | | $2,944.31 | $3,436.55 | $4,352.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.14 / $1,679.17 / $2,976.32
| Professional | | $1,555.14 | $1,679.17 | $2,976.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,007.56 / $2,007.56 / $2,673.93
| Professional | | $2,007.56 | $2,007.56 | $2,673.93 |