- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $8,709.64 / $11,748.98
| Professional | | $7,413.10 | $8,709.64 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Professional | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $16,982.44 / $16,982.44
| Facility | | $9,120.11 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $13,803.84 / $16,982.44
| Professional | | $6,606.93 | $13,803.84 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $15,848.93 / $30,902.95
| Facility | | $12,022.64 | $15,848.93 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $15,848.93 / $30,902.95
| Professional | | $12,022.64 | $15,848.93 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $12,589.25 / $19,054.61
| Facility | | $7,244.36 | $12,589.25 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $12,882.50 / $16,982.44
| Professional | | $79.43 | $12,882.50 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $9,120.11 / $9,772.37
| Facility | | $8,128.31 | $9,120.11 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,165.95 / $9,332.54
| Professional | | $5,495.41 | $6,165.95 | $9,332.54 |