- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,959.77 / $3,481.61 / $18,360.20
| Professional | | $2,959.77 | $3,481.61 | $18,360.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,093.88 / $14,093.88 / $16,886.06
| Professional | | $14,093.88 | $14,093.88 | $16,886.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.91 / $4,694.64 / $6,428.10
| Facility | | $3,473.91 | $4,694.64 | $6,428.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,722.31 / $6,529.93 / $9,542.07
| Professional | | $3,722.31 | $6,529.93 | $9,542.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,887.05 / $6,014.62 / $7,505.20
| Professional | | $4,887.05 | $6,014.62 | $7,505.20 |