- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.35 / $2,166.79 / $2,708.49
| Professional | | $1,354.35 | $2,166.79 | $2,708.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.44 / $361.13 / $361.13
| Professional | | $263.44 | $361.13 | $361.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,672.64 / $2,672.64 / $3,407.14
| Facility | | $2,672.64 | $2,672.64 | $3,407.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.73 / $2,672.64 / $4,729.50
| Professional | | $2,271.73 | $2,672.64 | $4,729.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,496.69 / $2,843.91 / $19,176.53
| Facility | | $2,496.69 | $2,843.91 | $19,176.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,364.85 / $2,074.59 / $3,120.86
| Professional | | $1,364.85 | $2,074.59 | $3,120.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,706.07 / $2,074.59 / $3,120.86
| Professional | | $1,706.07 | $2,074.59 | $3,120.86 |