- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,737.78 / $3,884.94 / $6,218.78
| Professional | | $3,737.78 | $3,884.94 | $6,218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,071.96 / $7,484.98 / $13,532.54
| Facility | | $2,071.96 | $7,484.98 | $13,532.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,179.93 / $6,906.57 / $9,410.20
| Professional | | $5,179.93 | $6,906.57 | $9,410.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,751.45 / $4,751.45 / $4,751.45
| Facility | | $4,751.45 | $4,751.45 | $4,751.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,038.73 / $4,038.73 / $9,984.75
| Professional | | $4,038.73 | $4,038.73 | $9,984.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,571.52 / $4,273.43 / $39,447.21
| Facility | | $2,571.52 | $4,273.43 | $39,447.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,428.69 / $3,793.57 / $5,845.78
| Professional | | $3,428.69 | $3,793.57 | $5,845.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,428.69 / $3,793.57 / $5,714.49
| Professional | | $3,428.69 | $3,793.57 | $5,714.49 |