- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,727.27 / $2,185.36 / $3,008.50
| Professional | | $1,727.27 | $2,185.36 | $3,008.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.53 / $4,210.47 / $7,612.35
| Facility | | $1,165.53 | $4,210.47 | $7,612.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,913.81 / $3,885.08 / $5,293.42
| Professional | | $2,913.81 | $3,885.08 | $5,293.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,141.52 / $3,141.52 / $3,141.52
| Facility | | $3,141.52 | $3,141.52 | $3,141.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,293.31 / $2,293.31 / $5,629.88
| Professional | | $2,293.31 | $2,293.31 | $5,629.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.07 / $3,244.87 / $18,963.50
| Facility | | $1,173.07 | $3,244.87 | $18,963.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.31 / $1,817.08 / $2,800.07
| Professional | | $1,642.31 | $1,817.08 | $2,800.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.31 / $1,817.08 / $2,737.18
| Professional | | $1,642.31 | $1,817.08 | $2,737.18 |