- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $47,863.01 / $91,201.08
| Facility | | $20,892.96 | $47,863.01 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $11,748.98 / $45,708.82
| Professional | | $9,772.37 | $11,748.98 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $40,738.03 / $85,113.80
| Facility | | $17,782.79 | $40,738.03 | $85,113.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,197.01 / $23,988.33 / $45,708.82
| Professional | | $18,197.01 | $23,988.33 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $13,182.57
| Professional | | $10,964.78 | $10,964.78 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $15,848.93 / $100,000.00
| Facility | | $6,760.83 | $15,848.93 | $100,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,471.29 / $114,815.36
| Professional | | $9,332.54 | $10,471.29 | $114,815.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $14,454.40 / $16,218.10
| Facility | | $173.78 | $14,454.40 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,471.29 / $15,848.93
| Professional | | $9,332.54 | $10,471.29 | $15,848.93 |