- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.78 / $1,363.56 / $1,704.45
| Professional | | $731.78 | $1,363.56 | $1,704.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.63 / $227.26 / $227.26
| Professional | | $154.63 | $227.26 | $227.26 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $259.52 / $1,642.79 / $11,644.83
| Facility | | $259.52 | $1,642.79 | $11,644.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.99 / $1,170.18 / $1,727.26
| Professional | | $745.99 | $1,170.18 | $1,727.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.10 / $1,160.43 / $1,724.07
| Professional | | $804.10 | $1,160.43 | $1,724.07 |