- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,125.38 / $26,915.35 / $50,118.72
| Facility | | $14,125.38 | $26,915.35 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,125.38 / $15,848.93 / $18,197.01
| Professional | | $14,125.38 | $15,848.93 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,113.11 / $56,234.13 / $70,794.58
| Facility | | $33,113.11 | $56,234.13 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $10,000.00 / $10,000.00
| Professional | | $0.03 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $75,857.76 / $208,929.61
| Facility | | $18,197.01 | $75,857.76 | $208,929.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $32,359.37
| Professional | | $16,218.10 | $16,218.10 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,848.93 / $26,302.68 / $64,565.42
| Facility | | $15,848.93 | $26,302.68 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $17,782.79 / $25,703.96
| Professional | | $50.12 | $17,782.79 | $25,703.96 |