- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $10,232.93
| Professional | | $6,456.54 | $6,456.54 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $3,715.35 / $5,128.61
| Professional | | $776.25 | $3,715.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,943.28 / $10,232.93
| Professional | | $7,585.78 | $7,943.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $5,888.44
| Professional | | $524.81 | $524.81 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $741.31 / $4,897.79
| Facility | | $549.54 | $741.31 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,248.07 / $7,079.46
| Professional | | $3,467.37 | $5,248.07 | $7,079.46 |