- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $13,489.63
| Facility | | $11,220.18 | $11,220.18 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,128.31 / $9,772.37 / $15,488.17
| Professional | | $8,128.31 | $9,772.37 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $21,877.62 / $25,118.86
| Facility | | $20,417.38 | $21,877.62 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Professional | | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $14,791.08
| Facility | | $12,589.25 | $12,589.25 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $12,589.25
| Professional | | $9,120.11 | $9,120.11 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $17,378.01 / $30,902.95
| Professional | | $17,378.01 | $17,378.01 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,481.54 / $13,182.57
| Facility | | $5,370.32 | $11,481.54 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,715.19 / $17,378.01
| Professional | | $7,762.47 | $10,715.19 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $17,782.79 / $28,840.32
| Facility | | $17,782.79 | $17,782.79 | $28,840.32 |