- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,111.66 / $1,323.53 / $2,071.75
| Professional | | $1,111.66 | $1,323.53 | $2,071.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.17 / $2,789.46 / $5,043.22
| Facility | | $772.17 | $2,789.46 | $5,043.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,930.41 / $2,573.88 / $3,506.91
| Professional | | $1,930.41 | $2,573.88 | $3,506.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.76 / $1,552.76 / $1,552.76
| Facility | | $1,552.76 | $1,552.76 | $1,552.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.51 / $1,133.51 / $3,519.75
| Professional | | $1,133.51 | $1,133.51 | $3,519.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.34 / $2,049.73 / $13,558.52
| Facility | | $800.34 | $2,049.73 | $13,558.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.48 / $1,239.72 / $1,910.37
| Professional | | $1,120.48 | $1,239.72 | $1,910.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,120.48 / $1,239.72 / $1,867.47
| Professional | | $1,120.48 | $1,239.72 | $1,867.47 |