- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,370.32 / $13,182.57
| Professional | | $4,466.84 | $5,370.32 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,760.83 / $14,454.40
| Professional | | $4,265.80 | $6,760.83 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,511.38 / $9,332.54
| Facility | | $8,317.64 | $8,511.38 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,511.38 / $9,332.54
| Professional | | $8,317.64 | $8,511.38 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,606.93 / $12,302.69
| Facility | | $2,754.23 | $6,606.93 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $7,762.47 / $12,589.25
| Professional | | $79.43 | $7,762.47 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,317.64 / $10,232.93
| Professional | | $6,309.57 | $8,317.64 | $10,232.93 |