- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,962.91 / $4,992.27 / $8,257.10
| Professional | | $4,962.91 | $4,992.27 | $8,257.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.54 / $9,618.44 / $17,389.74
| Facility | | $2,662.54 | $9,618.44 | $17,389.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,656.36 / $8,875.15 / $12,092.39
| Professional | | $6,656.36 | $8,875.15 | $12,092.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,732.85 / $8,732.85 / $8,732.85
| Facility | | $8,732.85 | $8,732.85 | $8,732.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,374.98 / $6,374.98 / $15,650.25
| Professional | | $6,374.98 | $6,374.98 | $15,650.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.07 / $7,412.66 / $58,756.37
| Facility | | $3,573.07 | $7,412.66 | $58,756.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,002.30 / $5,534.64 / $8,528.70
| Professional | | $5,002.30 | $5,534.64 | $8,528.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.86 / $5,544.86 / $5,544.86
| Facility | | $5,544.86 | $5,544.86 | $5,544.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,002.30 / $5,534.64 / $8,528.70
| Professional | | $5,002.30 | $5,534.64 | $8,528.70 |