- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $9,772.37
| Facility | | $8,128.31 | $8,128.31 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,244.36 / $12,022.64
| Professional | | $6,309.57 | $7,244.36 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $15,848.93 / $18,197.01
| Facility | | $14,791.08 | $15,848.93 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Professional | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $10,715.19
| Facility | | $9,332.54 | $9,332.54 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $9,332.54
| Professional | | $6,918.31 | $6,918.31 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $22,387.21
| Professional | | $12,589.25 | $12,589.25 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $9,549.93 / $10,715.19
| Facility | | $4,365.16 | $9,549.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,762.47 / $12,589.25
| Professional | | $5,623.41 | $7,762.47 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $20,892.96
| Facility | | $12,882.50 | $12,882.50 | $20,892.96 |