- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,144.71 / $4,235.41 / $6,895.81
| Professional | | $4,144.71 | $4,235.41 | $6,895.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.89 / $8,160.23 / $14,753.36
| Facility | | $2,258.89 | $8,160.23 | $14,753.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,647.22 / $7,529.62 / $10,259.11
| Professional | | $5,647.22 | $7,529.62 | $10,259.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,553.03 / $6,553.03 / $6,553.03
| Facility | | $6,553.03 | $6,553.03 | $6,553.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,783.71 / $4,783.71 / $11,743.88
| Professional | | $4,783.71 | $4,783.71 | $11,743.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.30 / $6,288.85 / $46,975.22
| Facility | | $2,920.30 | $6,288.85 | $46,975.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,088.42 / $4,523.51 / $6,970.60
| Professional | | $4,088.42 | $4,523.51 | $6,970.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,088.42 / $4,523.51 / $6,814.04
| Professional | | $4,088.42 | $4,523.51 | $6,814.04 |