- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,011.87 / $14,125.38
| Professional | | $3,467.37 | $5,011.87 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $18,197.01 / $21,379.62
| Facility | | $13,489.63 | $18,197.01 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,786.30 / $9,772.37
| Professional | | $3,630.78 | $4,786.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $6,606.93
| Facility | | $5,248.07 | $5,248.07 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $6,606.93
| Professional | | $4,786.30 | $4,786.30 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,165.95 / $10,964.78
| Facility | | $5,248.07 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,248.07 / $7,585.78
| Professional | | $4,168.69 | $5,248.07 | $7,585.78 |