- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,042.58 / $2,739.56 / $3,836.45
| Professional | | $2,042.58 | $2,739.56 | $3,836.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.30 / $5,773.84 / $10,438.87
| Facility | | $1,598.30 | $5,773.84 | $10,438.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,995.73 / $5,327.64 / $7,258.91
| Professional | | $3,995.73 | $5,327.64 | $7,258.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,853.06 / $2,853.06 / $2,853.06
| Facility | | $2,853.06 | $2,853.06 | $2,853.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,082.73 / $2,082.73 / $6,673.50
| Professional | | $2,082.73 | $2,082.73 | $6,673.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.57 / $4,067.77 / $24,371.76
| Facility | | $1,470.57 | $4,067.77 | $24,371.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.79 / $2,277.89 / $3,510.16
| Professional | | $2,058.79 | $2,277.89 | $3,510.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,058.79 / $2,277.89 / $3,431.32
| Professional | | $2,058.79 | $2,277.89 | $3,431.32 |