- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,108.00 / $6,266.81 / $7,892.46
| Facility | | $6,108.00 | $6,266.81 | $7,892.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,913.74 / $6,376.49 / $8,835.71
| Professional | | $4,913.74 | $6,376.49 | $8,835.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,616.81 / $13,459.76 / $24,950.15
| Facility | | $10,616.81 | $13,459.76 | $24,950.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,430.09 / $6,486.08 / $10,577.97
| Professional | | $6,430.09 | $6,486.08 | $10,577.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,302.44 / $8,302.44 / $8,302.44
| Facility | | $8,302.44 | $8,302.44 | $8,302.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,060.78 / $8,124.02 / $8,551.51
| Professional | | $6,060.78 | $8,124.02 | $8,551.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,413.84 / $5,881.61 / $8,351.85
| Professional | | $4,413.84 | $5,881.61 | $8,351.85 |