- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,724.29 / $6,907.00 / $10,086.15
| Facility | | $6,724.29 | $6,907.00 | $10,086.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.59 / $723.53 / $774.87
| Professional | | $676.59 | $723.53 | $774.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $688.74 / $958.73 / $1,331.66
| Professional | | $688.74 | $958.73 | $1,331.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,144.21 / $8,144.21 / $8,144.21
| Facility | | $8,144.21 | $8,144.21 | $8,144.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.84 / $965.38 / $1,759.21
| Professional | | $744.84 | $965.38 | $1,759.21 |