- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $14,125.38 / $17,378.01
| Facility | | $9,772.37 | $14,125.38 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,079.46 / $28,840.32
| Professional | | $5,248.07 | $7,079.46 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $19,952.62
| Professional | | $19,952.62 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,317.64 / $40,738.03
| Facility | | $6,760.83 | $8,317.64 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,489.63 / $17,378.01 / $38,904.51
| Professional | | $13,489.63 | $17,378.01 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $35,481.34
| Professional | | $22,908.68 | $22,908.68 | $35,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $28,840.32 / $41,686.94
| Facility | | $8,317.64 | $28,840.32 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $5,754.40 / $19,952.62
| Professional | | $60.26 | $5,754.40 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $15,848.93 / $36,307.81
| Professional | | $12,022.64 | $15,848.93 | $36,307.81 |