- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,760.83 / $10,964.78
| Facility | | $4,570.88 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,772.37 / $12,302.69
| Professional | | $6,606.93 | $9,772.37 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $17,378.01 / $36,307.81
| Facility | | $9,120.11 | $17,378.01 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,762.47 / $20,892.96
| Professional | | $1,412.54 | $7,762.47 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $21,877.62
| Facility | | $8,912.51 | $12,589.25 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $13,803.84 / $28,183.83
| Professional | | $5,011.87 | $13,803.84 | $28,183.83 |