- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,035.10 / $5,322.82 / $5,898.26
| Professional | | $5,035.10 | $5,322.82 | $5,898.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,193.00 / $8,471.92 / $9,207.04
| Facility | | $7,193.00 | $8,471.92 | $9,207.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,394.75 / $5,394.75 / $8,789.12
| Professional | | $5,394.75 | $5,394.75 | $8,789.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,267.22 / $21,267.22 / $21,267.22
| Facility | | $21,267.22 | $21,267.22 | $21,267.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,689.10 / $9,872.12 / $20,088.53
| Professional | | $3,689.10 | $9,872.12 | $20,088.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,021.06 / $4,315.80 / $10,374.45
| Professional | | $3,021.06 | $4,315.80 | $10,374.45 |