- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $16,982.44 / $16,982.44
| Facility | | $16,982.44 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $20,892.96 / $33,884.42
| Professional | | $15,488.17 | $20,892.96 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $39,810.72
| Facility | | $39,810.72 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $30,902.95
| Professional | | $30,902.95 | $30,902.95 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,302.68 / $43,651.58 / $57,543.99
| Professional | | $26,302.68 | $43,651.58 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,904.51 / $38,904.51 / $38,904.51
| Professional | | $38,904.51 | $38,904.51 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $38,018.94 / $44,668.36
| Facility | | $16,595.87 | $38,018.94 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $21,379.62 / $34,673.69
| Professional | | $19,498.45 | $21,379.62 | $34,673.69 |