- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,082.45 / $5,789.43 / $13,927.25
| Facility | | $4,082.45 | $5,789.43 | $13,927.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,431.68 / $5,581.73 / $7,905.14
| Professional | | $3,431.68 | $5,581.73 | $7,905.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,318.74 / $5,292.92 / $10,966.34
| Facility | | $3,318.74 | $5,292.92 | $10,966.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,900.93 / $4,964.35 / $6,578.83
| Professional | | $2,900.93 | $4,964.35 | $6,578.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.83 / $2,329.40 / $4,446.72
| Facility | | $2,234.83 | $2,329.40 | $4,446.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,426.08 / $8,426.08 / $8,426.08
| Professional | | $8,426.08 | $8,426.08 | $8,426.08 |