- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,114.15 / $2,128.21 / $3,517.44
| Professional | | $2,114.15 | $2,128.21 | $3,517.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.63 / $4,485.39 / $8,109.41
| Facility | | $1,241.63 | $4,485.39 | $8,109.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,104.07 / $4,138.76 / $5,639.06
| Professional | | $3,104.07 | $4,138.76 | $5,639.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,001.57 / $3,001.57 / $3,001.57
| Facility | | $3,001.57 | $3,001.57 | $3,001.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,191.15 / $2,191.15 / $5,907.75
| Professional | | $2,191.15 | $2,191.15 | $5,907.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,341.03 / $2,899.65 / $21,089.02
| Facility | | $2,341.03 | $2,899.65 | $21,089.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,826.14 / $1,975.10 / $3,043.56
| Professional | | $1,826.14 | $1,975.10 | $3,043.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,826.14 / $1,975.10 / $3,043.56
| Professional | | $1,826.14 | $1,975.10 | $3,043.56 |