- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,166.93 / $3,795.43 / $6,648.32
| Professional | | $3,166.93 | $3,795.43 | $6,648.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.03 / $6,101.63 / $11,031.49
| Facility | | $1,689.03 | $6,101.63 | $11,031.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,222.58 / $5,630.10 / $7,671.02
| Professional | | $4,222.58 | $5,630.10 | $7,671.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,697.47 / $4,697.47 / $4,697.47
| Facility | | $4,697.47 | $4,697.47 | $4,697.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,429.16 / $3,429.16 / $8,418.37
| Professional | | $3,429.16 | $3,429.16 | $8,418.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,266.64 / $4,762.63 / $35,737.98
| Facility | | $2,266.64 | $4,762.63 | $35,737.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,173.29 / $3,511.00 / $5,410.34
| Professional | | $3,173.29 | $3,511.00 | $5,410.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,173.29 / $3,511.00 / $5,288.82
| Professional | | $3,173.29 | $3,511.00 | $5,288.82 |