- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,350.08 / $3,151.98 / $4,134.35
| Professional | | $2,350.08 | $3,151.98 | $4,134.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,681.06 / $6,072.81 / $10,979.40
| Facility | | $1,681.06 | $6,072.81 | $10,979.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,202.64 / $5,603.53 / $7,634.81
| Professional | | $4,202.64 | $5,603.53 | $7,634.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,943.38 / $3,943.38 / $3,943.38
| Facility | | $3,943.38 | $3,943.38 | $3,943.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,878.67 / $2,878.67 / $7,066.88
| Professional | | $2,878.67 | $2,878.67 | $7,066.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.96 / $4,680.14 / $27,719.31
| Facility | | $1,691.96 | $4,680.14 | $27,719.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,620.82 / $4,038.60
| Professional | | $2,368.73 | $2,620.82 | $4,038.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,620.82 / $4,038.60
| Professional | | $2,368.73 | $2,620.82 | $4,038.60 |