- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,369.15 / $1,527.96 / $1,604.90
| Professional | | $1,369.15 | $1,527.96 | $1,604.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.17 / $1,407.16 / $1,855.87
| Professional | | $59.17 | $1,407.16 | $1,855.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,996.77 / $1,996.77 / $2,510.79
| Professional | | $1,996.77 | $1,996.77 | $2,510.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.19 / $1,601.19 / $3,119.03
| Facility | | $1,380.19 | $1,601.19 | $3,119.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.67 / $1,342.67 / $1,342.67
| Professional | | $1,342.67 | $1,342.67 | $1,342.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.67 / $1,342.67 / $1,342.67
| Professional | | $1,342.67 | $1,342.67 | $1,342.67 |