- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,187.29 / $10,187.32 / $21,406.10
| Facility | | $10,187.29 | $10,187.32 | $21,406.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,768.57 / $10,391.07 / $10,666.01
| Professional | | $9,768.57 | $10,391.07 | $10,666.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,910.81 / $19,158.45 / $21,406.09
| Facility | | $16,910.81 | $19,158.45 | $21,406.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,724.54 / $11,663.83 / $16,096.08
| Professional | | $10,724.54 | $11,663.83 | $16,096.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,054.57 / $23,546.70 / $29,968.53
| Facility | | $16,054.57 | $23,546.70 | $29,968.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,195.18 / $23,546.70 / $28,898.22
| Professional | | $18,195.18 | $23,546.70 | $28,898.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,847.37 / $13,847.37 / $21,406.09
| Facility | | $13,847.37 | $13,847.37 | $21,406.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $13,847.37 / $21,958.50
| Professional | | $10,108.58 | $13,847.37 | $21,958.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,379.26 / $10,679.26 / $14,745.38
| Professional | | $6,379.26 | $10,679.26 | $14,745.38 |