- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,662.00 / $19,107.96 / $29,507.32
| Professional | | $15,662.00 | $19,107.96 | $29,507.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,224.42 / $8,035.73 / $14,528.27
| Facility | | $2,224.42 | $8,035.73 | $14,528.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,561.05 / $7,414.74 / $10,102.58
| Professional | | $5,561.05 | $7,414.74 | $10,102.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,019.05 / $31,019.05 / $44,937.75
| Professional | | $31,019.05 | $31,019.05 | $44,937.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,228.20 / $27,706.21 / $182,487.33
| Facility | | $17,228.20 | $27,706.21 | $182,487.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,218.03 / $19,874.21 / $33,123.69
| Professional | | $18,218.03 | $19,874.21 | $33,123.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,874.21 / $19,874.21 / $33,123.69
| Professional | | $19,874.21 | $19,874.21 | $33,123.69 |