- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,353.05 / $4,898.64 / $8,150.19
| Professional | | $4,353.05 | $4,898.64 | $8,150.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,539.63 / $9,174.42 / $16,586.97
| Facility | | $2,539.63 | $9,174.42 | $16,586.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,349.07 / $8,465.43 / $11,534.15
| Professional | | $6,349.07 | $8,465.43 | $11,534.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,503.37 / $7,503.37 / $7,503.37
| Facility | | $7,503.37 | $7,503.37 | $7,503.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,477.46 / $5,477.46 / $12,466.13
| Professional | | $5,477.46 | $5,477.46 | $12,466.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,034.15 / $6,741.47 / $48,813.24
| Facility | | $3,034.15 | $6,741.47 | $48,813.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,247.81 / $4,699.85 / $7,242.34
| Professional | | $4,247.81 | $4,699.85 | $7,242.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,247.81 / $4,699.85 / $7,079.68
| Professional | | $4,247.81 | $4,699.85 | $7,079.68 |