- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,912.51 / $10,715.19
| Professional | | $6,165.95 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $6,760.83
| Facility | | $1,071.52 | $1,071.52 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $7,244.36
| Professional | | $1,148.15 | $1,148.15 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $8,912.51 / $10,964.78
| Facility | | $1,659.59 | $8,912.51 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $10,000.00 / $10,000.00
| Professional | | $1,174.90 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,096.48 / $7,244.36
| Facility | | $912.01 | $1,096.48 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,495.41 / $8,511.38
| Professional | | $4,168.69 | $5,495.41 | $8,511.38 |