- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $6,606.93
| Professional | | $4,168.69 | $4,168.69 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $3,630.78 / $5,128.61
| Professional | | $562.34 | $3,630.78 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,772.37 / $9,772.37
| Professional | | $9,332.54 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $489.78 / $3,311.31
| Facility | | $363.08 | $489.78 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,467.37 / $5,370.32
| Professional | | $2,691.53 | $3,467.37 | $5,370.32 |