- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,955.01 / $26,370.27 / $29,395.61
| Facility | | $9,955.01 | $26,370.27 | $29,395.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,763.57 / $10,009.16 / $17,102.52
| Professional | | $9,763.57 | $10,009.16 | $17,102.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,690.69 / $20,680.47 / $20,680.47
| Professional | | $13,690.69 | $20,680.47 | $20,680.47 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $35,903.60 / $100,282.95 / $112,458.86
| Facility | | $35,903.60 | $100,282.95 | $112,458.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116,045.60 / $116,045.60 / $172,500.69
| Professional | | $116,045.60 | $116,045.60 | $172,500.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,642.42 / $11,463.62 / $15,814.07
| Professional | | $7,642.42 | $11,463.62 | $15,814.07 |