- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,436.25 / $4,846.14 / $5,063.22
| Professional | | $1,436.25 | $4,846.14 | $5,063.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,805.25 / $6,640.00 / $10,860.55
| Facility | | $1,805.25 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.05 / $926.73 / $1,158.41
| Professional | | $695.05 | $926.73 | $1,158.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.83 / $1,528.58 / $4,435.00
| Facility | | $972.83 | $1,528.58 | $4,435.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.31 / $1,116.97 / $10,107.12
| Professional | | $926.31 | $1,116.97 | $10,107.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.41 / $1,038.59 / $1,611.95
| Professional | | $878.41 | $1,038.59 | $1,611.95 |