- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,421.57 / $1,748.85 / $2,528.53
| Professional | | $1,421.57 | $1,748.85 | $2,528.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.72 / $3,369.45 / $6,091.83
| Facility | | $932.72 | $3,369.45 | $6,091.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,331.80 / $3,109.06 / $4,236.10
| Professional | | $2,331.80 | $3,109.06 | $4,236.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,476.09 / $2,476.09 / $2,476.09
| Facility | | $2,476.09 | $2,476.09 | $2,476.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,807.55 / $1,807.55 / $4,437.38
| Professional | | $1,807.55 | $1,807.55 | $4,437.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.47 / $2,596.73 / $16,803.40
| Facility | | $1,023.47 | $2,596.73 | $16,803.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,432.85 / $1,585.34 / $2,442.96
| Professional | | $1,432.85 | $1,585.34 | $2,442.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.78 / $1,585.34 / $2,388.09
| Professional | | $1,465.78 | $1,585.34 | $2,388.09 |