- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.49 / $2,036.90 / $2,769.32
| Professional | | $1,664.49 | $2,036.90 | $2,769.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.34 / $3,924.45 / $7,095.24
| Facility | | $1,086.34 | $3,924.45 | $7,095.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,715.87 / $3,621.16 / $4,933.83
| Professional | | $2,715.87 | $3,621.16 | $4,933.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,717.61 / $2,717.61 / $2,717.61
| Facility | | $2,717.61 | $2,717.61 | $2,717.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,983.86 / $1,983.86 / $4,977.38
| Professional | | $1,983.86 | $1,983.86 | $4,977.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.82 / $3,024.44 / $19,464.45
| Facility | | $1,191.82 | $3,024.44 | $19,464.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,668.55 / $1,846.11 / $2,844.80
| Professional | | $1,668.55 | $1,846.11 | $2,844.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,668.55 / $1,846.11 / $2,780.91
| Professional | | $1,668.55 | $1,846.11 | $2,780.91 |