- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $21,877.62 / $39,810.72
| Facility | | $18,620.87 | $21,877.62 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,197.01 / $21,379.62 / $33,884.42
| Professional | | $18,197.01 | $21,379.62 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,413.10 / $43,651.58
| Facility | | $5,370.32 | $7,413.10 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $51,286.14 / $275,422.87
| Professional | | $2,454.71 | $51,286.14 | $275,422.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53,703.18 / $117,489.76 / $288,403.15
| Facility | | $53,703.18 | $117,489.76 | $288,403.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,902.95 / $30,902.95 / $57,543.99
| Professional | | $30,902.95 | $30,902.95 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $25,118.86 / $44,668.36
| Facility | | $16,595.87 | $25,118.86 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,791.08 / $20,417.38 / $33,884.42
| Professional | | $14,791.08 | $20,417.38 | $33,884.42 |