- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $15,135.61 / $29,512.09
| Facility | | $12,589.25 | $15,135.61 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,302.69 / $14,791.08 / $24,547.09
| Professional | | $12,302.69 | $14,791.08 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $57,543.99
| Facility | | $11,748.98 | $16,218.10 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $17,782.79 / $33,884.42
| Professional | | $15,488.17 | $17,782.79 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $114,815.36
| Facility | | $16,218.10 | $16,218.10 | $114,815.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $41,686.94
| Professional | | $11,748.98 | $11,748.98 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $19,952.62 / $35,481.34
| Facility | | $12,882.50 | $19,952.62 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $14,454.40 / $22,387.21
| Professional | | $10,715.19 | $14,454.40 | $22,387.21 |