- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $33,113.11 / $33,113.11
| Facility | | $26,915.35 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $24,547.09 / $33,113.11
| Professional | | $18,620.87 | $24,547.09 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,113.11 / $43,651.58 / $47,863.01
| Professional | | $33,113.11 | $43,651.58 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44,668.36 / $44,668.36 / $56,234.13
| Professional | | $44,668.36 | $44,668.36 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $33,113.11 / $181,970.09
| Facility | | $26,915.35 | $33,113.11 | $181,970.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $20,892.96 / $39,810.72
| Professional | | $16,982.44 | $20,892.96 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $53,703.18 / $53,703.18
| Facility | | $19,952.62 | $53,703.18 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,791.08 / $23,442.29 / $44,668.36
| Professional | | $14,791.08 | $23,442.29 | $44,668.36 |