- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,257.40 / $24,159.11 / $24,159.11
| Facility | | $21,257.40 | $24,159.11 | $24,159.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,419.56 / $18,303.52 / $24,377.41
| Professional | | $12,419.56 | $18,303.52 | $24,377.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,524.00 / $16,524.00 / $31,571.84
| Facility | | $16,524.00 | $16,524.00 | $31,571.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,524.00 / $33,438.37 / $41,797.97
| Professional | | $16,524.00 | $33,438.37 | $41,797.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,318.68 / $29,900.34 / $42,845.80
| Professional | | $27,318.68 | $29,900.34 | $42,845.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,876.68 / $41,070.49 / $134,345.48
| Facility | | $18,876.68 | $41,070.49 | $134,345.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,239.02 / $18,755.28 / $39,214.82
| Professional | | $13,239.02 | $18,755.28 | $39,214.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,571.84 / $31,571.84 / $39,153.06
| Facility | | $31,571.84 | $31,571.84 | $39,153.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,585.89 / $37,312.17 / $60,333.12
| Professional | | $28,585.89 | $37,312.17 | $60,333.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,857.86 / $14,860.17 / $37,496.33
| Professional | | $12,857.86 | $14,860.17 | $37,496.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,127.64 / $28,127.64 / $28,127.64
| Facility | | $28,127.64 | $28,127.64 | $28,127.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,220.84 / $28,127.64 / $28,127.64
| Professional | | $22,220.84 | $28,127.64 | $28,127.64 |