- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,468.25 / $2,770.81 / $4,106.58
| Professional | | $2,468.25 | $2,770.81 | $4,106.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.53 / $5,839.71 / $10,557.95
| Facility | | $1,616.53 | $5,839.71 | $10,557.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,041.32 / $5,388.42 / $7,341.73
| Professional | | $4,041.32 | $5,388.42 | $7,341.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,728.42 / $3,728.42 / $3,728.42
| Facility | | $3,728.42 | $3,728.42 | $3,728.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,721.75 / $2,721.75 / $6,680.25
| Professional | | $2,721.75 | $2,721.75 | $6,680.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,047.89 / $3,762.02 / $26,807.65
| Facility | | $3,047.89 | $3,762.02 | $26,807.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,369.23 / $2,562.50 / $3,948.74
| Professional | | $2,369.23 | $2,562.50 | $3,948.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,313.71 / $2,562.50 / $3,856.19
| Professional | | $2,313.71 | $2,562.50 | $3,856.19 |