- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.81 / $1,767.90 / $2,439.63
| Professional | | $1,001.81 | $1,767.90 | $2,439.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.18 / $278.61 / $278.61
| Professional | | $232.18 | $278.61 | $278.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.76 / $1,406.76 / $2,560.64
| Facility | | $1,406.76 | $1,406.76 | $2,560.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.74 / $1,406.76 / $3,588.75
| Professional | | $229.74 | $1,406.76 | $3,588.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $200.00 / $387.75
| Professional | | $100.00 | $200.00 | $387.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.79 / $348.27 / $2,127.88
| Professional | | $212.79 | $348.27 | $2,127.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,085.76 / $1,353.72 / $2,437.30
| Professional | | $1,085.76 | $1,353.72 | $2,437.30 |