- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,549.93 / $12,302.69
| Professional | | $7,244.36 | $9,549.93 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $10,715.19 / $10,715.19
| Facility | | $6,918.31 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,715.19 / $25,118.86
| Professional | | $9,120.11 | $10,715.19 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,000.00 / $12,302.69
| Facility | | $7,762.47 | $10,000.00 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Professional | | $4,677.35 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,148.15 / $7,413.10
| Facility | | $870.96 | $1,148.15 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,248.07 / $6,918.31
| Professional | | $3,715.35 | $5,248.07 | $6,918.31 |