- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,337.24 / $22,358.33 / $27,659.65
| Facility | | $22,337.24 | $22,358.33 | $27,659.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,714.66 / $23,181.89 / $32,613.62
| Professional | | $18,714.66 | $23,181.89 | $32,613.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,907.21 / $45,541.62 / $86,291.94
| Facility | | $41,907.21 | $45,541.62 | $86,291.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,751.10 / $23,953.47 / $35,090.60
| Professional | | $23,751.10 | $23,953.47 | $35,090.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $30,391.12
| Facility | | $30,391.12 | $30,391.12 | $30,391.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $29,738.01 / $32,398.44
| Professional | | $22,185.52 | $29,738.01 | $32,398.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,513.22 / $21,910.41 / $31,233.29
| Professional | | $16,513.22 | $21,910.41 | $31,233.29 |