- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,888.44 / $15,848.93
| Professional | | $5,495.41 | $5,888.44 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $22,387.21 / $29,512.09
| Facility | | $20,892.96 | $22,387.21 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,709.64 / $11,748.98
| Professional | | $5,128.61 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,943.28 / $12,302.69
| Professional | | $6,309.57 | $7,943.28 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,128.31 / $11,481.54
| Professional | | $6,606.93 | $8,128.31 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,413.10 / $15,848.93
| Professional | | $5,495.41 | $7,413.10 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,511.38 / $11,748.98
| Professional | | $5,754.40 | $8,511.38 | $11,748.98 |