- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,983.78 / $8,683.56 / $9,479.98
| Professional | | $6,983.78 | $8,683.56 | $9,479.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,598.91 / $30,522.82 / $36,135.44
| Facility | | $22,598.91 | $30,522.82 | $36,135.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,139.98 / $8,399.98 / $14,048.33
| Professional | | $7,139.98 | $8,399.98 | $14,048.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,245.39 / $9,907.40 / $9,907.40
| Facility | | $9,245.39 | $9,907.40 | $9,907.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,232.40 / $9,907.40 / $9,907.40
| Professional | | $7,232.40 | $9,907.40 | $9,907.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,207.19 / $9,617.28 / $13,290.30
| Professional | | $7,207.19 | $9,617.28 | $13,290.30 |