- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,585.78 / $8,912.51
| Professional | | $5,888.44 | $7,585.78 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $6,309.57 / $9,549.93
| Professional | | $5,011.87 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $6,165.95
| Facility | | $5,128.61 | $5,128.61 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $4,365.16 / $5,248.07
| Professional | | $954.99 | $4,365.16 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,317.64 / $10,715.19
| Facility | | $4,786.30 | $8,317.64 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,265.80 / $7,079.46
| Professional | | $2,818.38 | $4,265.80 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,318.26 / $5,495.41
| Facility | | $380.19 | $1,318.26 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,265.80 / $6,918.31
| Professional | | $3,019.95 | $4,265.80 | $6,918.31 |