- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,583.34 / $4,026.86 / $6,069.30
| Professional | | $3,583.34 | $4,026.86 | $6,069.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,147.66 / $7,758.41 / $14,026.88
| Facility | | $2,147.66 | $7,758.41 | $14,026.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,369.15 / $7,158.86 / $9,753.95
| Professional | | $5,369.15 | $7,158.86 | $9,753.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,541.83 / $6,541.83 / $6,541.83
| Facility | | $6,541.83 | $6,541.83 | $6,541.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,775.54 / $4,775.54 / $11,723.63
| Professional | | $4,775.54 | $4,775.54 | $11,723.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,579.84 / $6,069.30 / $42,519.53
| Facility | | $2,579.84 | $6,069.30 | $42,519.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,611.78 / $3,996.14 / $6,157.94
| Professional | | $3,611.78 | $3,996.14 | $6,157.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,611.78 / $3,996.14 / $6,019.63
| Professional | | $3,611.78 | $3,996.14 | $6,019.63 |