- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.47 / $1,388.90 / $2,183.64
| Professional | | $1,312.47 | $1,388.90 | $2,183.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.30 / $2,927.22 / $5,292.30
| Facility | | $810.30 | $2,927.22 | $5,292.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,025.76 / $2,701.02 / $3,680.13
| Professional | | $2,025.76 | $2,701.02 | $3,680.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,373.71 / $2,373.71 / $2,373.71
| Facility | | $2,373.71 | $2,373.71 | $2,373.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.65 / $2,017.65 / $3,469.50
| Professional | | $2,017.65 | $2,017.65 | $3,469.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.27 / $2,062.29 / $13,967.65
| Facility | | $860.27 | $2,062.29 | $13,967.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.36 / $1,332.55 / $2,053.41
| Professional | | $1,204.36 | $1,332.55 | $2,053.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,204.36 / $1,332.55 / $2,007.29
| Professional | | $1,204.36 | $1,332.55 | $2,007.29 |