- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $967.98 / $1,579.08 / $2,554.56
| Professional | | $967.98 | $1,579.08 | $2,554.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.71 / $198.14 / $198.14
| Professional | | $142.71 | $198.14 | $198.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.79 / $1,786.79 / $3,476.21
| Facility | | $1,786.79 | $1,786.79 | $3,476.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.77 / $1,786.79 / $3,663.75
| Professional | | $1,518.77 | $1,786.79 | $3,663.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.35 / $264.19 / $327.60
| Professional | | $211.35 | $264.19 | $327.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,900.52 / $1,900.52 / $1,900.52
| Professional | | $1,900.52 | $1,900.52 | $1,900.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.26 / $1,379.44 / $2,368.04
| Professional | | $1,110.26 | $1,379.44 | $2,368.04 |