- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,377.25 / $31,127.93 / $35,992.40
| Facility | | $15,377.25 | $31,127.93 | $35,992.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,403.96 / $11,921.22 / $21,674.94
| Professional | | $10,403.96 | $11,921.22 | $21,674.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,006.39 / $12,562.19 / $18,430.49
| Professional | | $12,006.39 | $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 / $11,079.10 / $13,425.26
| Professional | | $11,079.10 | $11,079.10 | $13,425.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,403.96 / $18,352.57 / $100,282.95
| Facility | | $10,403.96 | $18,352.57 | $100,282.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,672.14 / $12,172.60 / $20,880.93
| Professional | | $8,672.14 | $12,172.60 | $20,880.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,672.14 / $11,464.46 / $16,463.43
| Professional | | $8,672.14 | $11,464.46 | $16,463.43 |