- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,344.23 / $3,548.13
| Professional | | $1,318.26 | $2,344.23 | $3,548.13 |
- 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
- $588.84 / $2,089.30 / $2,951.21
| Professional | | $588.84 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $2,884.03
| Facility | | $691.83 | $691.83 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $3,090.30 / $5,495.41
| Professional | | $707.95 | $3,090.30 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,019.95 / $5,128.61
| Professional | | $1,949.84 | $3,019.95 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,344.23 / $3,548.13
| Professional | | $1,318.26 | $2,344.23 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,884.03 / $5,011.87
| Professional | | $1,949.84 | $2,884.03 | $5,011.87 |