- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,079.46 / $9,332.54
| Professional | | $4,897.79 | $7,079.46 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $9,120.11
| Professional | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,709.64
| Facility | | $8,128.31 | $8,128.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $6,918.31 / $8,128.31
| Professional | | $977.24 | $6,918.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Professional | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,348.96 / $4,897.79
| Facility | | $309.03 | $1,348.96 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,365.16 / $7,244.36
| Professional | | $3,235.94 | $4,365.16 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $11,220.18
| Professional | | $8,317.64 | $8,317.64 | $11,220.18 |