- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.81 / $1,124.08 / $1,805.28
| Professional | | $768.81 | $1,124.08 | $1,805.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.40 / $135.40 / $135.40
| Professional | | $135.40 | $135.40 | $135.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.05 / $1,217.05 / $2,487.67
| Facility | | $1,217.05 | $1,217.05 | $2,487.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.49 / $1,481.59 / $2,685.94
| Professional | | $1,034.49 | $1,481.59 | $2,685.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.41 / $180.53 / $226.13
| Professional | | $144.41 | $180.53 | $226.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,725.18 / $1,725.18 / $1,725.18
| Professional | | $1,725.18 | $1,725.18 | $1,725.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.76 / $1,121.06 / $2,031.21
| Professional | | $800.76 | $1,121.06 | $2,031.21 |