- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $478.63 / $1,230.27
| Professional | | $436.52 | $478.63 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,380.38 / $1,659.59
| Professional | | $933.25 | $1,380.38 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $831.76 / $1,071.52
| Professional | | $616.60 | $831.76 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,309.57 / $18,197.01
| Facility | | $5,128.61 | $6,309.57 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $954.99 / $1,698.24
| Professional | | $549.54 | $954.99 | $1,698.24 |