- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,394.37 / $9,271.84 / $10,007.70
| Facility | | $8,394.37 | $9,271.84 | $10,007.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,676.08 / $9,071.33 / $11,751.27
| Professional | | $6,676.08 | $9,071.33 | $11,751.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.43 / $7,848.27 / $15,147.16
| Facility | | $1,223.43 | $7,848.27 | $15,147.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,671.03 / $6,671.03 / $10,991.35
| Professional | | $6,671.03 | $6,671.03 | $10,991.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,613.42 / $14,613.42 / $14,613.42
| Facility | | $14,613.42 | $14,613.42 | $14,613.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,777.03 / $10,777.03 / $14,530.87
| Professional | | $10,777.03 | $10,777.03 | $14,530.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,037.72 / $6,567.65 / $10,775.87
| Professional | | $5,037.72 | $6,567.65 | $10,775.87 |