- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,663.06 / $8,281.95 / $8,281.95
| Professional | | $6,663.06 | $8,281.95 | $8,281.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,936.85 / $14,169.69 / $26,266.14
| Facility | | $10,936.85 | $14,169.69 | $26,266.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,777.58 / $7,079.50 / $9,231.93
| Professional | | $6,777.58 | $7,079.50 | $9,231.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,620.74 / $8,732.85 / $9,038.06
| Facility | | $8,620.74 | $8,732.85 | $9,038.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,374.98 / $6,374.98 / $8,732.85
| Professional | | $6,374.98 | $6,374.98 | $8,732.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,956.24 / $9,956.24 / $9,956.24
| Professional | | $9,956.24 | $9,956.24 | $9,956.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,923.95 / $8,281.95 / $8,281.95
| Professional | | $6,923.95 | $8,281.95 | $8,281.95 |
- 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
- $4,089.85 / $6,134.78 / $14,108.08
| Professional | | $4,089.85 | $6,134.78 | $14,108.08 |