- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.32 / $1,668.76 / $2,339.38
| Professional | | $1,277.32 | $1,668.76 | $2,339.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.01 / $3,215.15 / $5,812.86
| Facility | | $890.01 | $3,215.15 | $5,812.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,225.02 / $2,966.69 / $4,042.11
| Professional | | $2,225.02 | $2,966.69 | $4,042.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.15 / $1,784.15 / $1,784.15
| Facility | | $1,784.15 | $1,784.15 | $1,784.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.43 / $1,302.43 / $4,212.38
| Professional | | $1,302.43 | $1,302.43 | $4,212.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.62 / $2,477.81 / $15,230.69
| Facility | | $919.62 | $2,477.81 | $15,230.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.46 / $1,424.47 / $2,195.07
| Professional | | $1,287.46 | $1,424.47 | $2,195.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,287.46 / $1,424.47 / $2,145.77
| Professional | | $1,287.46 | $1,424.47 | $2,145.77 |