- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $12,302.69
| Professional | | $7,943.28 | $10,471.29 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,511.38 / $13,182.57
| Professional | | $6,760.83 | $8,511.38 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,715.19 / $10,715.19
| Facility | | $6,918.31 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $9,120.11 / $10,715.19
| Professional | | $1,288.25 | $9,120.11 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $11,481.54 / $14,454.40
| Facility | | $6,606.93 | $11,481.54 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,754.40 / $9,772.37
| Professional | | $3,890.45 | $5,754.40 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,778.28 / $7,413.10
| Facility | | $524.81 | $1,778.28 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,754.40 / $9,120.11
| Professional | | $4,073.80 | $5,754.40 | $9,120.11 |