- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,563.01 / $9,541.68 / $11,927.10
| Professional | | $5,563.01 | $9,541.68 | $11,927.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.07 / $1,590.28 / $1,590.28
| Professional | | $1,082.07 | $1,590.28 | $1,590.28 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $1,005.41 / $10,018.76 / $12,523.46
| Facility | | $1,005.41 | $10,018.76 | $12,523.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,480.39 / $5,800.65 / $9,734.10
| Professional | | $3,480.39 | $5,800.65 | $9,734.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,278.60 / $5,788.20 / $9,734.10
| Professional | | $4,278.60 | $5,788.20 | $9,734.10 |