- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,149.10 / $90,602.66 / $90,602.66
| Facility | | $23,149.10 | $90,602.66 | $90,602.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,279.42 / $10,654.00 / $17,102.52
| Professional | | $10,279.42 | $10,654.00 | $17,102.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,792.32 / $64,274.76 / $116,206.09
| Facility | | $17,792.32 | $64,274.76 | $116,206.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,539.21 / $20,718.93 / $28,229.56
| Professional | | $15,539.21 | $20,718.93 | $28,229.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,034.23 / $13,034.23 / $13,034.23
| Facility | | $13,034.23 | $13,034.23 | $13,034.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,079.10 / $11,079.10 / $27,402.38
| Professional | | $11,079.10 | $11,079.10 | $27,402.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,718.30 / $15,819.35 / $100,282.95
| Facility | | $6,718.30 | $15,819.35 | $100,282.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,405.62 / $10,406.57 / $16,036.20
| Professional | | $9,405.62 | $10,406.57 | $16,036.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,405.62 / $10,406.57 / $15,895.11
| Professional | | $9,405.62 | $10,406.57 | $15,895.11 |