- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,533.12 / $9,705.42 / $12,511.84
| Facility | | $9,533.12 | $9,705.42 | $12,511.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,987.08 / $9,670.79 / $12,963.41
| Professional | | $7,987.08 | $9,670.79 | $12,963.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,036.75 / $18,753.97 / $34,021.14
| Facility | | $17,036.75 | $18,753.97 | $34,021.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,344.35 / $10,344.35 / $14,177.41
| Professional | | $10,344.35 | $10,344.35 | $14,177.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,736.82 / $11,736.82 / $11,736.82
| Facility | | $11,736.82 | $11,736.82 | $11,736.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $11,484.62 / $12,512.04
| Professional | | $8,567.87 | $11,484.62 | $12,512.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,071.99 / $8,980.34 / $13,608.46
| Professional | | $7,071.99 | $8,980.34 | $13,608.46 |