- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.63 / $1,713.58 / $2,125.67
| Professional | | $1,277.63 | $1,713.58 | $2,125.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.91 / $3,301.51 / $5,968.99
| Facility | | $913.91 | $3,301.51 | $5,968.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,284.78 / $3,046.37 / $4,150.68
| Professional | | $2,284.78 | $3,046.37 | $4,150.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,050.41 / $2,050.41 / $2,050.41
| Facility | | $2,050.41 | $2,050.41 | $2,050.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,496.80 / $1,496.80 / $3,373.13
| Professional | | $1,496.80 | $1,496.80 | $3,373.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.83 / $2,544.37 / $15,093.28
| Facility | | $919.83 | $2,544.37 | $15,093.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.77 / $1,424.81 / $2,195.59
| Professional | | $1,287.77 | $1,424.81 | $2,195.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.77 / $1,424.81 / $2,180.34
| Professional | | $1,287.77 | $1,424.81 | $2,180.34 |