- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,317.64 / $14,125.38
| Facility | | $8,128.31 | $8,317.64 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,317.64 / $10,232.93
| Professional | | $8,128.31 | $8,317.64 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Facility | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $8,709.64
| Professional | | $8,709.64 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $8,317.64 / $10,232.93
| Facility | | $851.14 | $8,317.64 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,912.51 / $37,153.52
| Professional | | $7,244.36 | $8,912.51 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,709.64 / $9,772.37
| Professional | | $8,128.31 | $8,709.64 | $9,772.37 |