- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $38,018.94 / $47,863.01
| Facility | | $20,417.38 | $38,018.94 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,379.62 / $32,359.37 / $44,668.36
| Professional | | $21,379.62 | $32,359.37 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $58.88 / $75.86
| Facility | | $52.48 | $58.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $42,657.95 / $117,489.76
| Professional | | $38,018.94 | $42,657.95 | $117,489.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $39,810.72
| Facility | | $39,810.72 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $38,018.94 / $39,810.72
| Professional | | $38,018.94 | $38,018.94 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $74,131.02 / $89,125.09
| Facility | | $45,708.82 | $74,131.02 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45,708.82 / $51,286.14 / $77,624.71
| Professional | | $45,708.82 | $51,286.14 | $77,624.71 |