- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,235.11 / $15,667.90 / $24,210.00
| Facility | | $9,235.11 | $15,667.90 | $24,210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,477.75 / $9,477.75 / $9,477.75
| Professional | | $9,477.75 | $9,477.75 | $9,477.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,702.66 / $12,419.64 / $17,192.78
| Facility | | $6,702.66 | $12,419.64 | $17,192.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,065.76 / $7,582.20 / $10,200.41
| Facility | | $6,065.76 | $7,582.20 | $10,200.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,184.52 / $4,549.32 / $37,759.36
| Professional | | $3,184.52 | $4,549.32 | $37,759.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,184.52 / $4,549.32 / $12,131.52
| Professional | | $3,184.52 | $4,549.32 | $12,131.52 |