- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $4,677.35
| Professional | | $2,089.30 | $2,570.40 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $13,489.63 / $18,197.01
| Facility | | $12,589.25 | $13,489.63 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,311.31 / $5,495.41
| Professional | | $1,905.46 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $3,890.45
| Facility | | $691.83 | $691.83 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,951.21 / $5,370.32
| Professional | | $1,047.13 | $2,951.21 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,890.45 / $6,606.93
| Professional | | $2,570.40 | $3,890.45 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,388.44 / $7,244.36
| Professional | | $2,137.96 | $3,388.44 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,235.94 / $5,128.61
| Professional | | $2,187.76 | $3,235.94 | $5,128.61 |