- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.77 / $1,373.77 / $1,956.69
| Professional | | $1,373.77 | $1,373.77 | $1,956.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.86 / $352.86 / $352.86
| Professional | | $352.86 | $352.86 | $352.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.53 / $3,437.18 / $4,274.57
| Facility | | $1,682.53 | $3,437.18 | $4,274.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.70 / $1,851.90 / $3,395.95
| Professional | | $1,031.70 | $1,851.90 | $3,395.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.30 / $954.69 / $3,497.00
| Professional | | $76.30 | $954.69 | $3,497.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.85 / $731.82 / $1,155.06
| Professional | | $609.85 | $731.82 | $1,155.06 |