- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,801.89 / $10,232.93
| Professional | | $3,630.78 | $3,801.89 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $13,803.84 / $16,218.10
| Professional | | $8,511.38 | $13,803.84 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,918.31 / $7,943.28
| Professional | | $4,677.35 | $6,918.31 | $7,943.28 |
- 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
- $4,073.80 / $8,128.31 / $13,182.57
| Professional | | $4,073.80 | $8,128.31 | $13,182.57 |