- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,606.93 / $19,054.61
| Professional | | $5,495.41 | $6,606.93 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $24,547.09 / $28,840.32
| Facility | | $17,782.79 | $24,547.09 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,456.54 / $13,182.57
| Professional | | $4,897.79 | $6,456.54 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $8,709.64
| Facility | | $7,079.46 | $7,079.46 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $8,709.64
| Professional | | $6,309.57 | $6,309.57 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,511.38 / $15,135.61
| Facility | | $7,244.36 | $8,511.38 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,079.46 / $10,232.93
| Professional | | $5,495.41 | $7,079.46 | $10,232.93 |