- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,997.01 / $11,060.58 / $13,028.21
| Facility | | $10,997.01 | $11,060.58 | $13,028.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,477.42 / $11,041.34 / $15,361.62
| Professional | | $9,477.42 | $11,041.34 | $15,361.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,100.32 / $22,626.12 / $38,959.08
| Facility | | $20,100.32 | $22,626.12 | $38,959.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,519.84 / $11,663.83 / $16,986.66
| Professional | | $11,519.84 | $11,663.83 | $16,986.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,847.37 / $13,847.37 / $13,847.37
| Facility | | $13,847.37 | $13,847.37 | $13,847.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $13,549.79 / $14,262.79
| Professional | | $10,108.58 | $13,549.79 | $14,262.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,974.08 / $10,685.27 / $15,176.20
| Professional | | $7,974.08 | $10,685.27 | $15,176.20 |