- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,265.80 / $6,025.60
| Professional | | $3,801.89 | $4,265.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,982.44 / $20,417.38
| Professional | | $11,220.18 | $16,982.44 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,079.46 / $13,803.84
| Professional | | $4,365.16 | $7,079.46 | $13,803.84 |
- 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
- $4,365.16 / $7,413.10 / $15,848.93
| Professional | | $4,365.16 | $7,413.10 | $15,848.93 |