- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,598.32 / $6,907.00 / $9,185.11
| Facility | | $2,598.32 | $6,907.00 | $9,185.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,002.05 / $1,011.02 / $1,088.68
| Professional | | $1,002.05 | $1,011.02 | $1,088.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.70 / $1,419.33 / $1,660.15
| Professional | | $1,015.70 | $1,419.33 | $1,660.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,505.31 / $14,505.31 / $19,519.03
| Facility | | $14,505.31 | $14,505.31 | $19,519.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,068.99 / $1,383.40 / $2,568.21
| Professional | | $1,068.99 | $1,383.40 | $2,568.21 |