- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,642.45 / $11,056.68 / $11,442.37
| Facility | | $9,642.45 | $11,056.68 | $11,442.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,123.58 / $11,056.68 / $11,751.27
| Professional | | $8,123.58 | $11,056.68 | $11,751.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,178.20 / $10,065.89 / $10,065.89
| Professional | | $9,178.20 | $10,065.89 | $10,065.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.81 / $10,777.03 / $17,925.00
| Professional | | $1,092.81 | $10,777.03 | $17,925.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,338.26 / $6,239.62 / $10,104.07
| Professional | | $4,338.26 | $6,239.62 | $10,104.07 |