- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,268.59 / $6,053.40 / $14,562.26
| Facility | | $4,268.59 | $6,053.40 | $14,562.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,588.14 / $5,836.23 / $8,265.57
| Professional | | $3,588.14 | $5,836.23 | $8,265.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,470.06 / $5,534.26 / $11,466.35
| Facility | | $3,470.06 | $5,534.26 | $11,466.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,033.20 / $5,190.71 / $6,878.80
| Professional | | $3,033.20 | $5,190.71 | $6,878.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,305.21 / $2,402.58 / $4,701.47
| Facility | | $2,305.21 | $2,402.58 | $4,701.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,793.54 / $8,793.54 / $8,793.54
| Professional | | $8,793.54 | $8,793.54 | $8,793.54 |