- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $11,748.98
| Professional | | $7,585.78 | $7,585.78 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $5,128.61 / $5,888.44
| Professional | | $912.01 | $5,128.61 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $9,120.11 / $11,748.98
| Professional | | $8,709.64 | $9,120.11 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $6,760.83
| Professional | | $707.95 | $707.95 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $5,623.41
| Facility | | $630.96 | $851.14 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $6,025.60 / $8,128.31
| Professional | | $3,981.07 | $6,025.60 | $8,128.31 |