- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,708.21 / $52,103.63 / $53,095.44
| Facility | | $15,708.21 | $52,103.63 | $53,095.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,126.71 / $18,228.47 / $19,968.25
| Professional | | $14,126.71 | $18,228.47 | $19,968.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,344.29 / $39,284.56 / $62,232.26
| Facility | | $10,344.29 | $39,284.56 | $62,232.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,274.20 / $9,512.00 / $18,964.55
| Professional | | $9,274.20 | $9,512.00 | $18,964.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,087.50 / $16,087.50 / $16,087.50
| Professional | | $16,087.50 | $16,087.50 | $16,087.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,126.71 / $19,968.25 / $28,554.61
| Facility | | $14,126.71 | $19,968.25 | $28,554.61 |