- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $6,309.57
| Professional | | $2,137.96 | $2,570.40 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $3,235.94
| Professional | | $2,187.76 | $2,754.23 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $645.65
| Facility | | $512.86 | $512.86 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $5,495.41
| Professional | | $2,137.96 | $3,019.95 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,884.03 / $4,466.84
| Professional | | $2,511.89 | $2,884.03 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $371.54 / $2,398.83
| Facility | | $158.49 | $371.54 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,818.38 / $5,011.87
| Professional | | $1,949.84 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,019.95 / $3,890.45
| Professional | | $2,137.96 | $3,019.95 | $3,890.45 |