- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $25,118.86 / $42,657.95
| Facility | | $20,417.38 | $25,118.86 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $25,118.86 / $40,738.03
| Professional | | $20,417.38 | $25,118.86 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $28,183.83 / $95,499.26
| Facility | | $20,892.96 | $28,183.83 | $95,499.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,703.96 / $28,183.83 / $58,884.37
| Professional | | $25,703.96 | $28,183.83 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,622.78 / $31,622.78 / $199,526.23
| Facility | | $31,622.78 | $31,622.78 | $199,526.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $70,794.58
| Professional | | $22,908.68 | $22,908.68 | $70,794.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $33,113.11 / $58,884.37
| Facility | | $21,379.62 | $33,113.11 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,782.79 / $23,988.33 / $36,307.81
| Professional | | $17,782.79 | $23,988.33 | $36,307.81 |