- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,360.13 / $3,771.83 / $19,423.90
| Professional | | $3,360.13 | $3,771.83 | $19,423.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,904.21 / $5,904.21 / $5,904.21
| Facility | | $5,904.21 | $5,904.21 | $5,904.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,268.91 / $5,889.88 / $10,942.20
| Professional | | $3,268.91 | $5,889.88 | $10,942.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,181.76 / $4,734.93 / $7,311.70
| Facility | | $2,181.76 | $4,734.93 | $7,311.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,777.12 / $6,029.33 / $10,047.03
| Professional | | $3,777.12 | $6,029.33 | $10,047.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,195.35 / $6,411.31 / $8,288.65
| Professional | | $5,195.35 | $6,411.31 | $8,288.65 |