- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.12 / $2,799.49 / $4,073.50
| Professional | | $2,103.12 | $2,799.49 | $4,073.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,633.26 / $5,900.17 / $10,667.26
| Facility | | $1,633.26 | $5,900.17 | $10,667.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,083.15 / $5,444.20 / $7,417.72
| Professional | | $4,083.15 | $5,444.20 | $7,417.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,798.08 / $3,798.08 / $3,798.08
| Facility | | $3,798.08 | $3,798.08 | $3,798.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,772.60 / $2,772.60 / $6,806.63
| Professional | | $2,772.60 | $2,772.60 | $6,806.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.15 / $4,156.76 / $24,802.46
| Facility | | $1,514.15 | $4,156.76 | $24,802.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.82 / $2,345.41 / $3,614.20
| Professional | | $2,119.82 | $2,345.41 | $3,614.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,119.82 / $2,345.41 / $3,533.03
| Professional | | $2,119.82 | $2,345.41 | $3,533.03 |