- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $15,135.61 / $32,359.37
| Facility | | $12,302.69 | $15,135.61 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,302.69 / $14,791.08 / $23,988.33
| Professional | | $12,302.69 | $14,791.08 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,595.87 / $57,543.99
| Facility | | $12,022.64 | $16,595.87 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $22,387.21 / $37,153.52
| Professional | | $3,162.28 | $22,387.21 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $109,647.82
| Facility | | $16,595.87 | $16,595.87 | $109,647.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $41,686.94
| Professional | | $12,022.64 | $12,022.64 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $19,952.62 / $34,673.69
| Facility | | $489.78 | $19,952.62 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $14,454.40 / $22,387.21
| Professional | | $10,000.00 | $14,454.40 | $22,387.21 |