- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,754.40 / $13,803.84
| Professional | | $5,011.87 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,488.17 / $18,620.87
| Professional | | $11,481.54 | $15,488.17 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $9,332.54 / $14,125.38
| Professional | | $7,943.28 | $9,332.54 | $14,125.38 |
- 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
- $6,456.54 / $11,220.18 / $20,892.96
| Professional | | $6,456.54 | $11,220.18 | $20,892.96 |