- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.47 / $1,750.17 / $1,883.09
| Professional | | $1,506.47 | $1,750.17 | $1,883.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.82 / $336.26 / $443.86
| Professional | | $285.82 | $336.26 | $443.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,326.17 / $2,880.02 / $3,101.56
| Facility | | $2,326.17 | $2,880.02 | $3,101.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,215.40 / $2,658.48 / $3,323.10
| Professional | | $2,215.40 | $2,658.48 | $3,323.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.86 / $2,698.48 / $6,466.17
| Professional | | $443.86 | $2,698.48 | $6,466.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.47 / $1,329.24 / $2,434.71
| Professional | | $930.47 | $1,329.24 | $2,434.71 |