- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,387.21 / $36,307.81 / $69,183.10
| Facility | | $22,387.21 | $36,307.81 | $69,183.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,387.21 / $23,442.29 / $28,183.83
| Professional | | $22,387.21 | $23,442.29 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $30,902.95 / $64,565.42
| Facility | | $3,548.13 | $30,902.95 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $23,442.29 / $26,302.68
| Professional | | $3,019.95 | $23,442.29 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $23,988.33 / $37,153.52
| Facility | | $6,456.54 | $23,988.33 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $23,988.33 / $23,988.33
| Professional | | $4,265.80 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $43,651.58
| Facility | | $23,988.33 | $23,988.33 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,988.33 / $26,302.68
| Professional | | $23,442.29 | $23,988.33 | $26,302.68 |