- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.56 / $1,855.88 / $1,920.62
| Professional | | $1,363.56 | $1,855.88 | $1,920.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.38 / $1,689.54 / $1,689.54
| Professional | | $1,554.38 | $1,689.54 | $1,689.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.60 / $1,436.52 / $2,532.06
| Facility | | $192.60 | $1,436.52 | $2,532.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.43 / $1,221.04 / $3,759.38
| Professional | | $183.43 | $1,221.04 | $3,759.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.29 / $1,047.28 / $1,600.41
| Professional | | $728.29 | $1,047.28 | $1,600.41 |