- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,818.38 / $5,011.87
| Professional | | $2,238.72 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $10,471.29 / $14,125.38
| Facility | | $9,772.37 | $10,471.29 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,630.78 / $6,025.60
| Professional | | $2,238.72 | $3,630.78 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $4,265.80
| Facility | | $691.83 | $691.83 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,235.94 / $5,754.40
| Professional | | $1,047.13 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,265.80 / $7,413.10
| Professional | | $2,884.03 | $4,265.80 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,388.44 / $8,128.31
| Professional | | $2,290.87 | $3,388.44 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $5,495.41
| Professional | | $2,398.83 | $3,388.44 | $5,495.41 |