- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,343.64 / $26,370.27 / $52,052.50
| Facility | | $12,343.64 | $26,370.27 | $52,052.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,040.56 / $11,921.22 / $17,123.20
| Professional | | $10,040.56 | $11,921.22 | $17,123.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,562.19 / $12,562.19 / $29,054.63
| Facility | | $12,562.19 | $12,562.19 | $29,054.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,528.24 / $12,562.19 / $18,430.49
| Professional | | $12,528.24 | $12,562.19 | $18,430.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,034.23 / $13,034.23 / $13,034.23
| Facility | | $13,034.23 | $13,034.23 | $13,034.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,079.10 / $12,991.15 / $13,425.26
| Professional | | $11,079.10 | $12,991.15 | $13,425.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,749.08 / $11,589.61 / $16,930.11
| Professional | | $8,749.08 | $11,589.61 | $16,930.11 |