- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,721.50 / $7,907.03 / $8,401.87
| Professional | | $6,721.50 | $7,907.03 | $8,401.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.58 / $1,023.48 / $11,226.30
| Facility | | $831.58 | $1,023.48 | $11,226.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.58 / $895.55 / $12,089.86
| Professional | | $831.58 | $895.55 | $12,089.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,109.46 / $5,109.46 / $8,589.12
| Facility | | $5,109.46 | $5,109.46 | $8,589.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.20 / $4,343.04 / $5,109.46
| Professional | | $904.20 | $4,343.04 | $5,109.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,996.57 / $4,255.04 / $6,971.00
| Professional | | $2,996.57 | $4,255.04 | $6,971.00 |