- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $7,943.28
| Professional | | $3,388.44 | $4,168.69 | $7,943.28 |
- 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
- $3,235.94 / $5,623.41 / $9,332.54
| Professional | | $3,235.94 | $5,623.41 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $6,606.93
| Facility | | $691.83 | $691.83 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,011.87 / $8,912.51
| Professional | | $1,047.13 | $5,011.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,456.54 / $11,481.54
| Professional | | $4,365.16 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,248.07 / $12,302.69
| Professional | | $3,548.13 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,248.07 / $8,709.64
| Professional | | $3,630.78 | $5,248.07 | $8,709.64 |