- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,147.24 / $10,760.63 / $11,434.05
| Professional | | $9,147.24 | $10,760.63 | $11,434.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.70 / $1,392.86 / $7,199.04
| Facility | | $1,131.70 | $1,392.86 | $7,199.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.70 / $1,218.75 / $7,752.82
| Professional | | $1,131.70 | $1,218.75 | $7,752.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,694.63 / $10,694.63 / $11,688.69
| Facility | | $10,694.63 | $10,694.63 | $11,688.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.51 / $10,694.63 / $10,694.63
| Professional | | $1,230.51 | $10,694.63 | $10,694.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,077.98 / $5,790.64 / $9,115.60
| Professional | | $4,077.98 | $5,790.64 | $9,115.60 |