- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,218.10 / $16,982.44
| Facility | | $12,022.64 | $16,218.10 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,964.78 / $17,378.01
| Professional | | $8,912.51 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $30,902.95 / $43,651.58
| Facility | | $18,197.01 | $30,902.95 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $14,791.08
| Professional | | $14,791.08 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $12,882.50
| Facility | | $12,882.50 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $19,952.62
| Professional | | $9,332.54 | $9,332.54 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $16,595.87 / $25,703.96
| Facility | | $12,302.69 | $16,595.87 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,232.93 / $14,454.40
| Professional | | $6,309.57 | $10,232.93 | $14,454.40 |