- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,019.97 / $1,363.66 / $1,696.98
| Professional | | $1,019.97 | $1,363.66 | $1,696.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $795.58 / $2,874.02 / $5,196.10
| Facility | | $795.58 | $2,874.02 | $5,196.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.94 / $2,651.92 / $3,613.24
| Professional | | $1,988.94 | $2,651.92 | $3,613.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.68 / $1,424.68 / $1,424.68
| Facility | | $1,424.68 | $1,424.68 | $1,424.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.02 / $1,040.02 / $3,478.88
| Professional | | $1,040.02 | $1,040.02 | $3,478.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.33 / $2,024.81 / $12,107.67
| Facility | | $734.33 | $2,024.81 | $12,107.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.06 / $1,137.47 / $1,752.80
| Professional | | $1,028.06 | $1,137.47 | $1,752.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.06 / $1,137.47 / $1,713.44
| Professional | | $1,028.06 | $1,137.47 | $1,713.44 |