- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,093.08 / $1,388.21 / $7,080.07
| Professional | | $1,093.08 | $1,388.21 | $7,080.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $774.48 / $6,542.11 / $7,456.44
| Facility | | $774.48 | $6,542.11 | $7,456.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,070.20 / $17,882.24 / $17,882.24
| Professional | | $5,070.20 | $17,882.24 | $17,882.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,812.00 / $5,812.00 / $5,812.00
| Facility | | $5,812.00 | $5,812.00 | $5,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,881.36 / $4,466.00 / $6,211.82
| Professional | | $2,881.36 | $4,466.00 | $6,211.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.04 / $4,226.76 / $4,297.42
| Professional | | $1,030.04 | $4,226.76 | $4,297.42 |