- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.74 / $946.44 / $1,627.17
| Professional | | $919.74 | $946.44 | $1,627.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.86 / $2,051.41 / $3,708.86
| Facility | | $567.86 | $2,051.41 | $3,708.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.66 / $1,892.88 / $2,579.05
| Professional | | $1,419.66 | $1,892.88 | $2,579.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.53 / $1,395.53 / $1,395.53
| Facility | | $1,395.53 | $1,395.53 | $1,395.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.74 / $1,018.74 / $2,500.88
| Professional | | $1,018.74 | $1,018.74 | $2,500.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.47 / $1,580.97 / $9,370.62
| Facility | | $574.47 | $1,580.97 | $9,370.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.45 / $889.85 / $1,340.43
| Professional | | $803.45 | $889.85 | $1,340.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.18 / $889.85 / $1,340.43
| Professional | | $754.18 | $889.85 | $1,340.43 |