- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,079.46 / $11,220.18
| Professional | | $5,011.87 | $7,079.46 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,715.19 / $17,782.79
| Facility | | $8,912.51 | $10,715.19 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $12,589.25 / $12,589.25
| Professional | | $11,748.98 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,709.64 / $8,709.64
| Facility | | $6,918.31 | $8,709.64 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $8,709.64
| Professional | | $6,309.57 | $6,309.57 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,332.54 / $14,791.08
| Facility | | $3,548.13 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,715.19 / $11,220.18
| Professional | | $9,332.54 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $10,715.19 / $10,715.19
| Facility | | $10,471.29 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $9,549.93 / $12,589.25
| Professional | | $7,943.28 | $9,549.93 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $11,220.18 / $14,454.40
| Professional | | $8,912.51 | $11,220.18 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,244.36 / $8,317.64
| Facility | | $4,466.84 | $7,244.36 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,495.41 / $8,511.38
| Professional | | $5,128.61 | $5,495.41 | $8,511.38 |