- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,309.57 / $8,511.38
| Professional | | $3,630.78 | $6,309.57 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $416.87 / $616.60
| Facility | | $371.54 | $416.87 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,232.93 / $22,387.21
| Professional | | $8,128.31 | $10,232.93 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,715.35 / $12,882.50
| Professional | | $3,162.28 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,760.83 / $9,332.54
| Facility | | $4,168.69 | $6,760.83 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,162.28 / $6,165.95
| Professional | | $2,630.27 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $1,122.02 / $4,897.79
| Facility | | $288.40 | $1,122.02 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,162.28 / $6,165.95
| Professional | | $2,630.27 | $3,162.28 | $6,165.95 |