- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,567.72 / $1,838.15 / $1,893.02
| Professional | | $1,567.72 | $1,838.15 | $1,893.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,920.45 / $1,920.45 / $2,315.98
| Professional | | $1,920.45 | $1,920.45 | $2,315.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.09 / $1,850.09 / $1,850.09
| Facility | | $1,850.09 | $1,850.09 | $1,850.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.23 / $1,572.58 / $4,560.93
| Professional | | $249.23 | $1,572.58 | $4,560.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.94 / $477.94 / $477.94
| Professional | | $477.94 | $477.94 | $477.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.87 / $1,555.14 / $2,565.58
| Professional | | $1,373.87 | $1,555.14 | $2,565.58 |