- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,746.13 / $16,715.12 / $23,740.31
| Facility | | $15,746.13 | $16,715.12 | $23,740.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,755.60 / $16,715.12 / $24,224.81
| Professional | | $12,755.60 | $16,715.12 | $24,224.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,358.53 / $43,321.23 / $60,893.90
| Facility | | $25,358.53 | $43,321.23 | $60,893.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,293.61 / $20,685.50 / $20,685.50
| Professional | | $17,293.61 | $20,685.50 | $20,685.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,511.20 / $25,511.20 / $25,511.20
| Facility | | $25,511.20 | $25,511.20 | $25,511.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,200.25 / $16,200.25 / $16,200.25
| Facility | | $16,200.25 | $16,200.25 | $16,200.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,826.18 / $16,200.25 / $16,200.25
| Professional | | $11,826.18 | $16,200.25 | $16,200.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,383.10 / $34,568.35 / $34,568.35
| Facility | | $29,383.10 | $34,568.35 | $34,568.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,622.87 / $14,536.25 / $19,931.41
| Professional | | $8,622.87 | $14,536.25 | $19,931.41 |