- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,785.90 / $3,736.51 / $4,992.37
| Professional | | $2,785.90 | $3,736.51 | $4,992.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,992.81 / $7,199.02 / $13,015.53
| Facility | | $1,992.81 | $7,199.02 | $13,015.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,982.01 / $6,642.68 / $9,050.65
| Professional | | $4,982.01 | $6,642.68 | $9,050.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,366.38 / $4,366.38 / $4,366.38
| Facility | | $4,366.38 | $4,366.38 | $4,366.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,187.46 / $3,187.46 / $7,825.13
| Professional | | $3,187.46 | $3,187.46 | $7,825.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.72 / $5,548.07 / $33,390.44
| Facility | | $2,005.72 | $5,548.07 | $33,390.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,808.01 / $3,106.84 / $4,787.54
| Professional | | $2,808.01 | $3,106.84 | $4,787.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,808.01 / $3,106.84 / $4,680.02
| Professional | | $2,808.01 | $3,106.84 | $4,680.02 |