- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,981.07 / $7,079.46
| Professional | | $3,162.28 | $3,981.07 | $7,079.46 |
- 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
- $2,951.21 / $5,128.61 / $8,317.64
| Professional | | $2,951.21 | $5,128.61 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $6,025.60
| Facility | | $691.83 | $691.83 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,466.84 / $8,128.31
| Professional | | $1,047.13 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,888.44 / $10,471.29
| Professional | | $3,981.07 | $5,888.44 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,786.30 / $11,220.18
| Professional | | $3,235.94 | $4,786.30 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,897.79 / $7,943.28
| Professional | | $3,388.44 | $4,897.79 | $7,943.28 |