- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $10,964.78
| Facility | | $4,570.88 | $6,309.57 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $2,238.72
| Professional | | $1,445.44 | $1,778.28 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,595.87 / $18,620.87
| Facility | | $8,709.64 | $16,595.87 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $11,481.54
| Professional | | $1,348.96 | $3,548.13 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,220.18 / $18,620.87
| Facility | | $7,244.36 | $11,220.18 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,951.21 / $5,888.44
| Professional | | $1,905.46 | $2,951.21 | $5,888.44 |