- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,378.01 / $19,952.62 / $32,359.37
| Facility | | $17,378.01 | $19,952.62 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $11,748.98 / $13,182.57
| Professional | | $7,079.46 | $11,748.98 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $18,620.87
| Facility | | $8,511.38 | $8,511.38 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $31,622.78
| Professional | | $31,622.78 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,265.80 / $5,370.32
| Facility | | $3,090.30 | $4,265.80 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,548.13 / $5,888.44
| Professional | | $3,388.44 | $3,548.13 | $5,888.44 |