- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,541.68 / $11,224.65 / $11,927.10
| Professional | | $9,541.68 | $11,224.65 | $11,927.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.49 / $1,452.91 / $15,936.63
| Facility | | $1,180.49 | $1,452.91 | $15,936.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.49 / $1,271.30 / $17,162.52
| Professional | | $1,180.49 | $1,271.30 | $17,162.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,155.72 / $11,155.72 / $12,192.66
| Facility | | $11,155.72 | $11,155.72 | $12,192.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.58 / $11,155.72 / $11,155.72
| Professional | | $1,283.58 | $11,155.72 | $11,155.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,640.52 / $6,040.36 / $9,734.10
| Professional | | $4,640.52 | $6,040.36 | $9,734.10 |