- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,981.07 / $9,332.54
| Professional | | $2,754.23 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,981.07 / $4,786.30
| Professional | | $2,344.23 | $3,981.07 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,897.79 / $5,248.07
| Facility | | $4,677.35 | $4,897.79 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,897.79 / $5,248.07
| Professional | | $4,677.35 | $4,897.79 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,168.69 / $6,025.60
| Facility | | $2,818.38 | $4,168.69 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $3,890.45 / $5,888.44
| Professional | | $79.43 | $3,890.45 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,786.30 / $5,495.41
| Professional | | $3,630.78 | $4,786.30 | $5,495.41 |