- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,372.83 / $6,663.06 / $7,293.22
| Professional | | $5,372.83 | $6,663.06 | $7,293.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,386.02 / $23,482.12 / $27,800.07
| Facility | | $17,386.02 | $23,482.12 | $27,800.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,493.00 / $6,462.35 / $10,807.80
| Professional | | $5,493.00 | $6,462.35 | $10,807.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,112.73 / $8,732.85 / $8,732.85
| Facility | | $7,112.73 | $8,732.85 | $8,732.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,374.98 / $8,732.85 / $8,732.85
| Professional | | $6,374.98 | $8,732.85 | $8,732.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,544.70 / $7,379.52 / $10,224.62
| Professional | | $5,544.70 | $7,379.52 | $10,224.62 |