- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.09 / $1,027.43 / $1,817.69
| Professional | | $806.09 | $1,027.43 | $1,817.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.07 / $1,911.27 / $3,455.50
| Facility | | $529.07 | $1,911.27 | $3,455.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,322.68 / $1,763.57 / $2,402.86
| Professional | | $1,322.68 | $1,763.57 | $2,402.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.63 / $1,335.63 / $1,335.63
| Facility | | $1,335.63 | $1,335.63 | $1,335.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.01 / $975.01 / $2,393.63
| Professional | | $975.01 | $975.01 | $2,393.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.04 / $1,152.71 / $9,614.69
| Facility | | $594.04 | $1,152.71 | $9,614.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.84 / $920.18 / $1,386.11
| Professional | | $830.84 | $920.18 | $1,386.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.67 / $920.18 / $1,386.11
| Professional | | $831.67 | $920.18 | $1,386.11 |