- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,354.60 / $5,386.28 / $8,908.78
| Professional | | $5,354.60 | $5,386.28 | $8,908.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,872.68 / $10,377.56 / $18,762.18
| Facility | | $2,872.68 | $10,377.56 | $18,762.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,181.71 / $9,575.61 / $13,046.77
| Professional | | $7,181.71 | $9,575.61 | $13,046.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,121.18 / $8,121.18 / $8,121.18
| Facility | | $8,121.18 | $8,121.18 | $8,121.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,928.46 / $5,928.46 / $14,554.13
| Professional | | $5,928.46 | $5,928.46 | $14,554.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,855.07 / $8,234.86 / $62,341.20
| Facility | | $3,855.07 | $8,234.86 | $62,341.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,397.10 / $5,971.46 / $9,201.83
| Professional | | $5,397.10 | $5,971.46 | $9,201.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,521.10 / $5,971.46 / $8,995.16
| Professional | | $5,521.10 | $5,971.46 | $8,995.16 |