- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,050.86 / $2,750.66 / $3,880.02
| Professional | | $2,050.86 | $2,750.66 | $3,880.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,467.02 / $5,299.60 / $9,581.45
| Facility | | $1,467.02 | $5,299.60 | $9,581.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,667.55 / $4,890.06 / $6,662.71
| Professional | | $3,667.55 | $4,890.06 | $6,662.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,670.30 / $3,670.30 / $3,670.30
| Facility | | $3,670.30 | $3,670.30 | $3,670.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,679.32 / $2,679.32 / $6,577.50
| Professional | | $2,679.32 | $2,679.32 | $6,577.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,476.53 / $4,084.26 / $24,492.50
| Facility | | $1,476.53 | $4,084.26 | $24,492.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,067.14 / $2,287.12 / $3,524.39
| Professional | | $2,067.14 | $2,287.12 | $3,524.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,114.63 / $2,287.12 / $3,445.23
| Professional | | $2,114.63 | $2,287.12 | $3,445.23 |