- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.61 / $1,359.53 / $4,948.06
| Professional | | $1,087.61 | $1,359.53 | $4,948.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.44 / $1,214.25 / $7,104.63
| Facility | | $776.44 | $1,214.25 | $7,104.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.00 / $9,451.00 / $10,880.52
| Professional | | $913.00 | $9,451.00 | $10,880.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,123.00 / $4,123.00 / $4,123.00
| Facility | | $4,123.00 | $4,123.00 | $4,123.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.08 / $4,341.41 / $4,557.00
| Professional | | $989.08 | $4,341.41 | $4,557.00 |