- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,037.84 / $8,640.90 / $10,801.13
| Professional | | $5,037.84 | $8,640.90 | $10,801.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,102.62 / $10,102.62 / $10,697.17
| Facility | | $10,102.62 | $10,102.62 | $10,697.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,162.40 / $10,102.62 / $19,068.75
| Professional | | $1,162.40 | $10,102.62 | $19,068.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.51 / $9,072.95 / $11,341.19
| Facility | | $910.51 | $9,072.95 | $11,341.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,151.84 / $5,253.07 / $8,525.29
| Professional | | $3,151.84 | $5,253.07 | $8,525.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,874.67 / $5,241.80 / $8,525.29
| Professional | | $3,874.67 | $5,241.80 | $8,525.29 |