- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,081.89 / $6,141.37 / $7,182.89
| Facility | | $6,081.89 | $6,141.37 | $7,182.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,858.34 / $6,225.17 / $7,937.39
| Professional | | $4,858.34 | $6,225.17 | $7,937.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,541.85 / $11,410.31 / $22,891.10
| Facility | | $10,541.85 | $11,410.31 | $22,891.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,324.72 / $6,433.43 / $8,878.12
| Professional | | $6,324.72 | $6,433.43 | $8,878.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,136.27 / $8,136.27 / $8,136.27
| Facility | | $8,136.27 | $8,136.27 | $8,136.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,939.48 / $7,961.42 / $8,380.36
| Professional | | $5,939.48 | $7,961.42 | $8,380.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,378.00 / $5,692.48 / $8,332.17
| Professional | | $4,378.00 | $5,692.48 | $8,332.17 |