- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,772.37 / $12,022.64
| Professional | | $6,760.83 | $9,772.37 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $15,848.93
| Facility | | $1,174.90 | $1,174.90 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $16,982.44
| Professional | | $1,258.93 | $1,258.93 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $9,772.37 / $12,302.69
| Facility | | $1,819.70 | $9,772.37 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $11,220.18 / $11,220.18
| Professional | | $1,288.25 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,202.26 / $8,128.31
| Facility | | $1,023.29 | $1,202.26 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,025.60 / $9,772.37
| Professional | | $4,677.35 | $6,025.60 | $9,772.37 |