- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $2,238.72
| Professional | | $1,000.00 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $13,489.63 / $18,197.01
| Facility | | $12,589.25 | $13,489.63 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $2,630.27
| Professional | | $977.24 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,862.09
| Facility | | $691.83 | $691.83 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,412.54 / $2,570.40
| Professional | | $812.83 | $1,412.54 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,862.09 / $3,235.94
| Professional | | $1,258.93 | $1,862.09 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,621.81 / $3,548.13
| Professional | | $1,023.29 | $1,621.81 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,454.71
| Professional | | $1,047.13 | $1,513.56 | $2,454.71 |