- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,236.55 / $2,290.36 / $3,810.62
| Professional | | $2,236.55 | $2,290.36 | $3,810.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.83 / $4,713.71 / $8,522.18
| Facility | | $1,304.83 | $4,713.71 | $8,522.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,262.09 / $4,349.45 / $5,926.12
| Professional | | $3,262.09 | $4,349.45 | $5,926.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,294.10 / $3,294.10 / $3,294.10
| Facility | | $3,294.10 | $3,294.10 | $3,294.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,404.69 / $2,404.69 / $5,903.25
| Professional | | $2,404.69 | $2,404.69 | $5,903.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,465.11 / $3,320.90 / $23,712.81
| Facility | | $1,465.11 | $3,320.90 | $23,712.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,051.16 / $2,269.44 / $3,497.15
| Professional | | $2,051.16 | $2,269.44 | $3,497.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,051.16 / $2,269.44 / $3,418.60
| Professional | | $2,051.16 | $2,269.44 | $3,418.60 |