- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,467.37 / $8,317.64
| Professional | | $3,388.44 | $3,467.37 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $8,912.51 / $10,715.19
| Professional | | $7,943.28 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,897.79 / $8,317.64
| Professional | | $4,570.88 | $4,897.79 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $3,090.30
| Facility | | $1,288.25 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,606.93 / $12,882.50
| Professional | | $4,677.35 | $6,606.93 | $12,882.50 |