- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,641.21 / $9,078.66 / $14,470.50
| Professional | | $7,641.21 | $9,078.66 | $14,470.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.96 / $12,835.77 / $31,782.45
| Professional | | $1,158.96 | $12,835.77 | $31,782.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.92 / $1,543.72 / $20,840.21
| Facility | | $869.92 | $1,543.72 | $20,840.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.72 / $1,543.72 / $1,543.72
| Professional | | $1,543.72 | $1,543.72 | $1,543.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,645.60 / $11,155.72 / $11,155.72
| Facility | | $6,645.60 | $11,155.72 | $11,155.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.58 / $11,155.72 / $21,056.25
| Professional | | $1,283.58 | $11,155.72 | $21,056.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,551.39 / $9,551.39 / $9,551.39
| Professional | | $9,551.39 | $9,551.39 | $9,551.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,560.31 / $6,040.36 / $11,194.22
| Professional | | $3,560.31 | $6,040.36 | $11,194.22 |