- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $16,595.87
| Professional | | $912.01 | $912.01 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46,773.51 / $81,283.05 / $95,499.26
| Facility | | $46,773.51 | $81,283.05 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,018.94 / $52,480.75 / $52,480.75
| Facility | | $38,018.94 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $52,480.75 / $52,480.75
| Professional | | $38,018.94 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $20,892.96
| Facility | | $912.01 | $912.01 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $79.43 / $85.11
| Professional | | $60.26 | $79.43 | $85.11 |