- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $15,848.93
| Professional | | $4,466.84 | $5,495.41 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $20,417.38 / $23,988.33
| Facility | | $15,135.61 | $20,417.38 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,495.41 / $10,964.78
| Professional | | $4,073.80 | $5,495.41 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Facility | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $6,606.93
| Professional | | $4,897.79 | $4,897.79 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,079.46 / $12,589.25
| Facility | | $6,025.60 | $7,079.46 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,888.44 / $8,709.64
| Professional | | $4,677.35 | $5,888.44 | $8,709.64 |