- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,754.40 / $6,918.31
| Professional | | $4,265.80 | $5,754.40 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $9,120.11
| Facility | | $676.08 | $676.08 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $9,772.37
| Professional | | $724.44 | $724.44 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $6,165.95 / $7,762.47
| Facility | | $1,148.15 | $6,165.95 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $7,585.78 / $7,585.78
| Professional | | $812.83 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $5,888.44
| Facility | | $630.96 | $741.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,801.89 / $5,754.40
| Professional | | $2,951.21 | $3,801.89 | $5,754.40 |