- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.36 / $967.41 / $1,273.75
| Professional | | $938.36 | $967.41 | $1,273.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,036.44 / $4,101.12 / $4,855.25
| Facility | | $3,036.44 | $4,101.12 | $4,855.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.33 / $1,402.74 / $1,942.13
| Professional | | $1,192.33 | $1,402.74 | $1,942.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.48 / $1,006.48 / $1,242.23
| Facility | | $1,006.48 | $1,006.48 | $1,242.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.73 / $734.73 / $734.73
| Professional | | $734.73 | $734.73 | $734.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.64 / $1,071.43 / $1,785.72
| Professional | | $729.64 | $1,071.43 | $1,785.72 |