- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.73 / $2,321.98 / $2,554.17
| Professional | | $706.73 | $2,321.98 | $2,554.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,853.46 / $3,838.27 / $7,247.10
| Facility | | $1,853.46 | $3,838.27 | $7,247.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.00 / $1,275.00 / $2,066.21
| Professional | | $1,121.00 | $1,275.00 | $2,066.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,477.78 / $4,529.79 / $6,413.71
| Facility | | $3,477.78 | $4,529.79 | $6,413.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.02 / $1,596.23 / $2,394.34
| Facility | | $903.02 | $1,596.23 | $2,394.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.39 / $1,055.39 / $1,055.39
| Professional | | $1,055.39 | $1,055.39 | $1,055.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,378.45 / $6,208.11 / $8,182.12
| Facility | | $5,378.45 | $6,208.11 | $8,182.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.03 / $1,355.21 / $1,963.30
| Professional | | $945.03 | $1,355.21 | $1,963.30 |