- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.91 / $1,599.25 / $2,523.58
| Professional | | $1,302.91 | $1,599.25 | $2,523.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.02 / $3,370.55 / $6,093.81
| Facility | | $933.02 | $3,370.55 | $6,093.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,332.56 / $3,110.08 / $4,237.47
| Professional | | $2,332.56 | $3,110.08 | $4,237.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.89 / $1,819.89 / $1,819.89
| Facility | | $1,819.89 | $1,819.89 | $1,819.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.52 / $1,328.52 / $4,039.50
| Professional | | $1,328.52 | $1,328.52 | $4,039.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.03 / $2,476.71 / $15,534.23
| Facility | | $938.03 | $2,476.71 | $15,534.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.25 / $1,453.01 / $2,239.04
| Professional | | $1,313.25 | $1,453.01 | $2,239.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,776.27 / $1,776.27 / $1,776.27
| Facility | | $1,776.27 | $1,776.27 | $1,776.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.25 / $1,453.01 / $2,239.04
| Professional | | $1,313.25 | $1,453.01 | $2,239.04 |