- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,741.39 / $1,851.72 / $2,897.27
| Professional | | $1,741.39 | $1,851.72 | $2,897.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,080.32 / $3,902.66 / $7,055.84
| Facility | | $1,080.32 | $3,902.66 | $7,055.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,700.80 / $3,601.06 / $4,906.45
| Professional | | $2,700.80 | $3,601.06 | $4,906.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,970.85 / $2,970.85 / $2,970.85
| Facility | | $2,970.85 | $2,970.85 | $2,970.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,168.71 / $2,168.71 / $4,887.38
| Professional | | $2,168.71 | $2,168.71 | $4,887.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.80 / $2,772.56 / $19,143.40
| Facility | | $1,192.80 | $2,772.56 | $19,143.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.91 / $1,847.62 / $2,847.13
| Professional | | $1,669.91 | $1,847.62 | $2,847.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.28 / $1,847.62 / $2,783.19
| Professional | | $1,708.28 | $1,847.62 | $2,783.19 |