- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,252.12 / $18,659.59 / $19,405.97
| Facility | | $14,252.12 | $18,659.59 | $19,405.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,659.81 / $20,625.75 / $25,041.32
| Professional | | $16,659.81 | $20,625.75 | $25,041.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,407.24 / $39,208.42 / $41,208.05
| Facility | | $24,407.24 | $39,208.42 | $41,208.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,829.90 / $23,548.73 / $23,953.47
| Professional | | $18,829.90 | $23,548.73 | $23,953.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,406.32 / $55,283.87 / $74,496.00
| Facility | | $29,406.32 | $55,283.87 | $74,496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39,208.42 / $52,931.37 / $65,772.53
| Professional | | $39,208.42 | $52,931.37 | $65,772.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,391.12 / $30,391.12 / $49,782.75
| Facility | | $30,391.12 | $30,391.12 | $49,782.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,185.52 / $30,391.12 / $208,654.67
| Professional | | $22,185.52 | $30,391.12 | $208,654.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,287.58 / $24,740.96 / $30,926.20
| Professional | | $20,287.58 | $24,740.96 | $30,926.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,040.44 / $20,213.68 / $30,142.37
| Professional | | $13,040.44 | $20,213.68 | $30,142.37 |