- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,337.38 / $3,128.78 / $4,144.17
| Professional | | $2,337.38 | $3,128.78 | $4,144.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,825.37 / $6,594.14 / $11,921.93
| Facility | | $1,825.37 | $6,594.14 | $11,921.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,563.43 / $6,084.57 / $8,290.21
| Professional | | $4,563.43 | $6,084.57 | $8,290.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,745.37 / $3,745.37 / $3,745.37
| Facility | | $3,745.37 | $3,745.37 | $3,745.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,734.12 / $2,734.12 / $6,712.13
| Professional | | $2,734.12 | $2,734.12 | $6,712.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,679.50 / $4,645.70 / $27,462.75
| Facility | | $1,679.50 | $4,645.70 | $27,462.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,351.30 / $2,601.52 / $4,008.86
| Professional | | $2,351.30 | $2,601.52 | $4,008.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,405.32 / $2,601.52 / $3,918.83
| Professional | | $2,405.32 | $2,601.52 | $3,918.83 |