- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,371.35 / $13,371.35 / $15,428.48
| Facility | | $13,371.35 | $13,371.35 | $15,428.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,371.35 / $15,428.48 / $15,662.00
| Professional | | $13,371.35 | $15,428.48 | $15,662.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,155.01 / $39,155.01 / $39,155.01
| Facility | | $39,155.01 | $39,155.01 | $39,155.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.59 / $54,000.00 / $54,000.00
| Professional | | $1,905.59 | $54,000.00 | $54,000.00 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $27,408.51 / $38,371.91 / $66,105.39
| Professional | | $27,408.51 | $38,371.91 | $66,105.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,776.64 / $19,874.21 / $33,123.69
| Professional | | $14,776.64 | $19,874.21 | $33,123.69 |