- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $22,387.21 / $38,018.94
| Facility | | $12,882.50 | $22,387.21 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Professional | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Professional | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $25,703.96 / $32,359.37
| Professional | | $20,417.38 | $25,703.96 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $45,708.82 / $61,659.50
| Facility | | $18,620.87 | $45,708.82 | $61,659.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $10,715.19 / $29,512.09
| Professional | | $724.44 | $10,715.19 | $29,512.09 |