- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,926.64 / $9,082.20 / $9,399.02
| Professional | | $6,926.64 | $9,082.20 | $9,399.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,854.70 / $7,450.76 / $7,450.76
| Professional | | $6,854.70 | $7,450.76 | $7,450.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,318.62 / $8,391.94 / $8,391.94
| Facility | | $8,318.62 | $8,391.94 | $8,391.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.52 / $7,133.15 / $16,584.38
| Professional | | $899.52 | $7,133.15 | $16,584.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,816.19 / $4,928.33 / $7,040.47
| Professional | | $2,816.19 | $4,928.33 | $7,040.47 |