- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,242.98 / $15,184.77 / $15,184.77
| Professional | | $11,242.98 | $15,184.77 | $15,184.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,102.62 / $10,102.62 / $10,102.62
| Facility | | $10,102.62 | $10,102.62 | $10,102.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,068.75 / $19,259.43 / $23,835.94
| Professional | | $19,068.75 | $19,259.43 | $23,835.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,693.64 / $11,041.73 / $30,805.77
| Facility | | $8,693.64 | $11,041.73 | $30,805.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,368.17 / $7,749.33 / $9,116.87
| Professional | | $4,368.17 | $7,749.33 | $9,116.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,504.28 / $1,504.28 / $3,457.27
| Facility | | $1,504.28 | $1,504.28 | $3,457.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,873.91 / $3,576.40 / $18,800.80
| Professional | | $1,873.91 | $3,576.40 | $18,800.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,640.59 / $5,470.12 / $9,116.87
| Professional | | $3,640.59 | $5,470.12 | $9,116.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,802.21 / $14,802.21 / $14,802.21
| Professional | | $14,802.21 | $14,802.21 | $14,802.21 |