- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,984.01 / $12,133.83 / $12,133.83
| Professional | | $8,984.01 | $12,133.83 | $12,133.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,072.81 / $8,072.81 / $8,072.81
| Facility | | $8,072.81 | $8,072.81 | $8,072.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,236.25 / $15,388.61 / $19,045.31
| Professional | | $15,236.25 | $15,388.61 | $19,045.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,946.81 / $8,823.10 / $24,616.19
| Facility | | $6,946.81 | $8,823.10 | $24,616.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,490.47 / $6,192.33 / $7,285.07
| Professional | | $3,490.47 | $6,192.33 | $7,285.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.04 / $1,202.04 / $2,762.61
| Facility | | $1,202.04 | $1,202.04 | $2,762.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.40 / $2,857.82 / $15,023.32
| Professional | | $1,497.40 | $2,857.82 | $15,023.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,314.23 / $4,371.04 / $7,285.07
| Professional | | $1,314.23 | $4,371.04 | $7,285.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,828.07 / $11,828.07 / $11,828.07
| Professional | | $11,828.07 | $11,828.07 | $11,828.07 |