- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,466.84 / $8,511.38
| Facility | | $3,311.31 | $4,466.84 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,630.78 / $4,466.84
| Professional | | $3,235.94 | $3,630.78 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,120.11 / $10,715.19
| Professional | | $6,309.57 | $9,120.11 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $6,918.31
| Professional | | $5,495.41 | $5,495.41 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,630.78 / $8,511.38
| Facility | | $2,884.03 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $9,549.93
| Professional | | $1,995.26 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,897.79 / $8,128.31
| Professional | | $1,995.26 | $4,897.79 | $8,128.31 |