- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,581.94 / $1,674.18 / $2,631.97
| Professional | | $1,581.94 | $1,674.18 | $2,631.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.74 / $3,528.49 / $6,379.36
| Facility | | $976.74 | $3,528.49 | $6,379.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,441.85 / $3,255.80 / $4,436.03
| Professional | | $2,441.85 | $3,255.80 | $4,436.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,861.13 / $2,861.13 / $2,861.13
| Facility | | $2,861.13 | $2,861.13 | $2,861.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,431.96 / $2,431.96 / $4,181.63
| Professional | | $2,431.96 | $2,431.96 | $4,181.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.91 / $2,485.87 / $16,835.74
| Facility | | $1,036.91 | $2,485.87 | $16,835.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,451.68 / $1,606.17 / $2,475.06
| Professional | | $1,451.68 | $1,606.17 | $2,475.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,451.68 / $1,606.17 / $2,419.46
| Professional | | $1,451.68 | $1,606.17 | $2,419.46 |