- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $32,359.37 / $81,283.05
| Facility | | $10,964.78 | $32,359.37 | $81,283.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $19,952.62
| Professional | | $9,772.37 | $12,022.64 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,022.64 / $30,199.52
| Facility | | $9,549.93 | $12,022.64 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,589.25 / $27,542.29
| Professional | | $12,022.64 | $12,589.25 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $89,125.09
| Facility | | $13,182.57 | $13,182.57 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $33,884.42
| Professional | | $10,964.78 | $10,964.78 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $14,454.40 / $16,218.10
| Facility | | $7,943.28 | $14,454.40 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,481.54 / $17,378.01
| Professional | | $8,709.64 | $11,481.54 | $17,378.01 |