- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,234.02 / $4,280.22 / $4,389.93
| Professional | | $3,234.02 | $4,280.22 | $4,389.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,465.02 / $14,134.37 / $16,733.45
| Facility | | $10,465.02 | $14,134.37 | $16,733.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,306.35 / $3,889.82 / $6,505.44
| Professional | | $3,306.35 | $3,889.82 | $6,505.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,281.32 / $4,938.58 / $4,938.58
| Facility | | $4,281.32 | $4,938.58 | $4,938.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,605.16 / $4,938.58 / $4,938.58
| Professional | | $3,605.16 | $4,938.58 | $4,938.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,337.47 / $4,227.06 / $6,154.42
| Professional | | $3,337.47 | $4,227.06 | $6,154.42 |