- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,128.31 / $12,302.69
| Professional | | $5,370.32 | $8,128.31 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,370.32
| Facility | | $5,248.07 | $5,248.07 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,248.07 / $5,495.41
| Professional | | $4,466.84 | $5,248.07 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $707.95 / $4,786.30
| Facility | | $630.96 | $707.95 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,801.89 / $7,079.46
| Professional | | $2,818.38 | $3,801.89 | $7,079.46 |