- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,130.47 / $1,254.29 / $2,045.13
| Professional | | $1,130.47 | $1,254.29 | $2,045.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,745.03 / $1,745.03 / $1,748.58
| Professional | | $1,745.03 | $1,745.03 | $1,748.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,482.94 / $1,482.94 / $1,482.94
| Facility | | $1,482.94 | $1,482.94 | $1,482.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.50 / $1,260.50 / $1,482.94
| Professional | | $1,260.50 | $1,260.50 | $1,482.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.54 / $2,557.92 / $3,683.40
| Professional | | $1,790.54 | $2,557.92 | $3,683.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.23 / $1,339.93 / $2,023.58
| Professional | | $1,152.23 | $1,339.93 | $2,023.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.38 / $1,436.07 / $1,790.54
| Professional | | $1,425.38 | $1,436.07 | $1,790.54 |