- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.51 / $1,884.13 / $3,093.39
| Professional | | $1,748.51 | $1,884.13 | $3,093.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.48 / $4,083.86 / $7,383.45
| Facility | | $1,130.48 | $4,083.86 | $7,383.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,826.19 / $3,768.26 / $5,134.25
| Professional | | $2,826.19 | $3,768.26 | $5,134.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,507.59 / $2,507.59 / $2,507.59
| Facility | | $2,507.59 | $2,507.59 | $2,507.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,830.54 / $1,830.54 / $4,494.00
| Professional | | $1,830.54 | $1,830.54 | $4,494.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.80 / $3,263.90 / $18,505.52
| Facility | | $1,137.80 | $3,263.90 | $18,505.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.33 / $1,762.45 / $2,654.88
| Professional | | $1,591.33 | $1,762.45 | $2,654.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.33 / $1,762.45 / $2,654.88
| Professional | | $1,591.33 | $1,762.45 | $2,654.88 |