- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,585.78 / $10,232.93
| Professional | | $5,623.41 | $7,585.78 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $8,128.31
| Professional | | $6,309.57 | $6,309.57 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $4,365.16 / $5,128.61
| Professional | | $954.99 | $4,365.16 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Professional | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $812.83 / $5,370.32
| Facility | | $724.44 | $812.83 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,168.69 / $4,897.79
| Professional | | $2,754.23 | $4,168.69 | $4,897.79 |