- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,318.27 / $11,341.15 / $14,237.72
| Facility | | $11,318.27 | $11,341.15 | $14,237.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.87 / $11,549.30 / $16,789.61
| Professional | | $9,772.87 | $11,549.30 | $16,789.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,898.50 / $23,442.42 / $43,797.00
| Facility | | $21,898.50 | $23,442.42 | $43,797.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,128.12 / $12,489.26 / $18,364.04
| Professional | | $12,128.12 | $12,489.26 | $18,364.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $14,513.81
| Facility | | $14,513.81 | $14,513.81 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $13,565.29 / $15,472.44
| Professional | | $10,595.08 | $13,565.29 | $15,472.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,337.33 / $11,253.89 / $15,942.11
| Professional | | $8,337.33 | $11,253.89 | $15,942.11 |