- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,471.29 / $28,840.32
| Professional | | $8,128.31 | $10,471.29 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $22,387.21 / $25,118.86
| Facility | | $18,620.87 | $22,387.21 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $19,054.61
| Professional | | $10,232.93 | $10,232.93 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $13,803.84
| Facility | | $11,748.98 | $11,748.98 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $11,748.98
| Professional | | $8,511.38 | $8,511.38 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $19,498.45
| Professional | | $16,595.87 | $16,595.87 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,715.19 / $28,840.32
| Professional | | $8,912.51 | $10,715.19 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,912.51 / $11,220.18
| Facility | | $5,370.32 | $8,912.51 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $12,882.50 / $17,782.79
| Professional | | $6,606.93 | $12,882.50 | $17,782.79 |