- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,177.46 / $27,645.22 / $64,379.11
| Facility | | $25,177.46 | $27,645.22 | $64,379.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,632.14 / $11,476.59 / $18,712.59
| Professional | | $9,632.14 | $11,476.59 | $18,712.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,293.91 / $15,293.91 / $15,293.91
| Professional | | $15,293.91 | $15,293.91 | $15,293.91 |
- 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
- $16,383.24 / $23,404.63 / $33,702.67
| Professional | | $16,383.24 | $23,404.63 | $33,702.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,542.68 / $12,260.13 / $18,515.46
| Professional | | $10,542.68 | $12,260.13 | $18,515.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,622.20 / $12,622.20 / $16,383.24
| Professional | | $12,622.20 | $12,622.20 | $16,383.24 |