- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,488.09 / $18,488.09 / $22,185.80
| Facility | | $18,488.09 | $18,488.09 | $22,185.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,300.35 / $12,571.93 / $18,488.14
| Professional | | $12,300.35 | $12,571.93 | $18,488.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,151.96 / $28,151.96 / $33,371.33
| Facility | | $28,151.96 | $28,151.96 | $33,371.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,048.93 / $22,275.00 / $22,275.00
| Professional | | $16,048.93 | $22,275.00 | $22,275.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,524.00 / $16,524.00 / $16,524.00
| Facility | | $16,524.00 | $16,524.00 | $16,524.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,062.52 / $12,062.52 / $16,524.00
| Professional | | $12,062.52 | $12,062.52 | $16,524.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,793.39 / $22,793.39 / $70,351.80
| Professional | | $22,793.39 | $22,793.39 | $70,351.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,996.86 / $19,813.56 / $22,793.39
| Professional | | $10,996.86 | $19,813.56 | $22,793.39 |