- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,394.37 / $11,508.41 / $12,049.98
| Facility | | $8,394.37 | $11,508.41 | $12,049.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,089.02 / $9,271.84 / $12,049.98
| Professional | | $7,089.02 | $9,271.84 | $12,049.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.22 / $1,483.22 / $1,631.54
| Facility | | $1,483.22 | $1,483.22 | $1,631.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.98 / $1,207.98 / $1,207.98
| Professional | | $1,207.98 | $1,207.98 | $1,207.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.81 / $10,777.03 / $10,777.03
| Professional | | $1,092.81 | $10,777.03 | $10,777.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,338.26 / $5,953.67 / $12,726.30
| Professional | | $4,338.26 | $5,953.67 | $12,726.30 |