- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,862.09 / $2,041.74
| Professional | | $1,380.38 | $1,862.09 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $3,162.28
| Professional | | $2,570.40 | $2,570.40 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,862.09 / $8,709.64
| Facility | | $794.33 | $1,862.09 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $1,698.24
| Professional | | $676.08 | $831.76 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,691.53 / $2,691.53
| Facility | | $1,096.48 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,230.27 / $2,344.23
| Professional | | $645.65 | $1,230.27 | $2,344.23 |