- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,945.55 / $9,148.34 / $9,467.45
| Professional | | $6,945.55 | $9,148.34 | $9,467.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,947.31 / $5,377.51 / $5,377.51
| Professional | | $4,947.31 | $5,377.51 | $5,377.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,109.46 / $5,109.46 / $8,321.02
| Facility | | $5,109.46 | $5,109.46 | $8,321.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.20 / $4,343.04 / $18,539.06
| Professional | | $904.20 | $4,343.04 | $18,539.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,449.26 / $4,015.34 / $6,971.00
| Professional | | $2,449.26 | $4,015.34 | $6,971.00 |