- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,200.16 / $15,087.73 / $15,570.90
| Facility | | $10,200.16 | $15,087.73 | $15,570.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,200.16 / $11,687.68 / $21,250.33
| Professional | | $10,200.16 | $11,687.68 | $21,250.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,326.11 / $23,442.42 / $103,057.32
| Facility | | $22,326.11 | $23,442.42 | $103,057.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,396.48 / $12,489.26 / $18,364.04
| Professional | | $11,396.48 | $12,489.26 | $18,364.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $14,513.81
| Facility | | $14,513.81 | $14,513.81 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $10,595.08 / $15,472.44
| Professional | | $10,595.08 | $10,595.08 | $15,472.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,200.16 / $17,993.05 / $104,478.94
| Facility | | $10,200.16 | $17,993.05 | $104,478.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,332.68 / $11,934.15 / $19,820.20
| Professional | | $8,332.68 | $11,934.15 | $19,820.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,332.68 / $11,138.25 / $15,810.25
| Professional | | $8,332.68 | $11,138.25 | $15,810.25 |