- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,995.34 / $30,331.81 / $59,601.57
| Facility | | $9,995.34 | $30,331.81 | $59,601.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,810.24 / $12,087.84 / $17,102.52
| Professional | | $9,810.24 | $12,087.84 | $17,102.52 |
- 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 / $11,079.10 / $13,034.23
| Professional | | $11,079.10 | $11,079.10 | $13,034.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,361.00 / $14,644.58 / $22,978.30
| Professional | | $10,361.00 | $14,644.58 | $22,978.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,382.64 / $18,382.64 / $18,382.64
| Professional | | $18,382.64 | $18,382.64 | $18,382.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,867.62 / $11,463.62 / $15,679.50
| Professional | | $9,867.62 | $11,463.62 | $15,679.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,562.19 / $12,562.19 / $22,978.30
| Professional | | $12,562.19 | $12,562.19 | $22,978.30 |