- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,120.11 / $15,135.61
| Professional | | $7,413.10 | $9,120.11 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $28,183.83
| Facility | | $9,772.37 | $9,772.37 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $19,498.45
| Professional | | $8,317.64 | $8,317.64 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $12,302.69 / $21,379.62
| Facility | | $10,471.29 | $12,302.69 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $8,709.64 / $12,302.69
| Professional | | $5,248.07 | $8,709.64 | $12,302.69 |