- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,918.31 / $8,912.51
| Professional | | $5,888.44 | $6,918.31 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,760.83 / $7,585.78
| Professional | | $6,025.60 | $6,760.83 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Professional | | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,772.37 / $12,589.25
| Professional | | $8,511.38 | $9,772.37 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,548.13 / $6,456.54
| Facility | | $1,548.82 | $3,548.13 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,659.59 / $3,715.35
| Professional | | $1,548.82 | $1,659.59 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,760.83 / $6,760.83
| Professional | | $4,265.80 | $6,760.83 | $6,760.83 |