- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,943.28 / $8,912.51
| Professional | | $4,786.30 | $7,943.28 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,128.61 / $5,248.07
| Professional | | $4,365.16 | $5,128.61 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $7,413.10
| Professional | | $6,760.83 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,677.35 / $5,888.44
| Professional | | $3,235.94 | $4,677.35 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $1,318.26 / $5,370.32
| Facility | | $389.05 | $1,318.26 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,168.69 / $5,623.41
| Professional | | $2,818.38 | $4,168.69 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Professional | | $6,309.57 | $6,309.57 | $6,309.57 |