- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.96 / $2,366.41 / $5,916.03
| Professional | | $1,698.96 | $2,366.41 | $5,916.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.16 / $239.16 / $1,835.48
| Professional | | $239.16 | $239.16 | $1,835.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,695.30 / $3,695.30 / $4,427.39
| Professional | | $3,695.30 | $3,695.30 | $4,427.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,033.86 / $3,033.86 / $3,033.86
| Professional | | $3,033.86 | $3,033.86 | $3,033.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,550.79 / $4,550.79 / $4,550.79
| Facility | | $4,550.79 | $4,550.79 | $4,550.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.22 / $1,274.22 / $3,033.86
| Professional | | $1,274.22 | $1,274.22 | $3,033.86 |