- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,859.74 / $12,986.77 / $13,439.80
| Professional | | $9,859.74 | $12,986.77 | $13,439.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,022.92 / $7,633.61 / $7,633.61
| Professional | | $7,022.92 | $7,633.61 | $7,633.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,155.72 / $11,155.72 / $11,812.31
| Facility | | $11,155.72 | $11,155.72 | $11,812.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.58 / $11,155.72 / $21,056.25
| Professional | | $1,283.58 | $11,155.72 | $21,056.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,476.88 / $5,747.96 / $9,734.10
| Professional | | $3,476.88 | $5,747.96 | $9,734.10 |