- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,655.84 / $1,695.65 / $2,821.17
| Professional | | $1,655.84 | $1,695.65 | $2,821.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.04 / $3,489.82 / $6,309.45
| Facility | | $966.04 | $3,489.82 | $6,309.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,415.10 / $3,220.13 / $4,387.42
| Professional | | $2,415.10 | $3,220.13 | $4,387.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,677.88 / $2,677.88 / $2,677.88
| Facility | | $2,677.88 | $2,677.88 | $2,677.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,954.85 / $1,954.85 / $4,370.63
| Professional | | $1,954.85 | $1,954.85 | $4,370.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,091.50 / $2,484.01 / $17,719.04
| Facility | | $1,091.50 | $2,484.01 | $17,719.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,528.10 / $1,690.72 / $2,605.35
| Professional | | $1,528.10 | $1,690.72 | $2,605.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,528.10 / $1,690.72 / $2,546.83
| Professional | | $1,528.10 | $1,690.72 | $2,546.83 |