- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,877.19 / $20,120.61 / $44,486.03
| Facility | | $12,877.19 | $20,120.61 | $44,486.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,087.84 / $18,929.68 / $20,120.61
| Professional | | $12,087.84 | $18,929.68 | $20,120.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,806.41 / $17,806.41 / $17,806.41
| Professional | | $17,806.41 | $17,806.41 | $17,806.41 |
- 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
- $6,937.71 / $11,463.62 / $16,036.20
| Professional | | $6,937.71 | $11,463.62 | $16,036.20 |