- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $12,302.69 / $16,595.87
| Professional | | $7,244.36 | $12,302.69 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $724.44 / $1,096.48
| Facility | | $660.69 | $724.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,454.40 / $18,197.01 / $39,810.72
| Professional | | $14,454.40 | $18,197.01 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $13,182.57 / $25,118.86
| Professional | | $1,513.56 | $13,182.57 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $13,182.57 / $18,197.01
| Facility | | $8,128.31 | $13,182.57 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,165.95 / $11,481.54
| Professional | | $5,128.61 | $6,165.95 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,187.76 / $9,549.93
| Facility | | $562.34 | $2,187.76 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,165.95 / $11,481.54
| Professional | | $5,128.61 | $6,165.95 | $11,481.54 |