- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,651.17 / $65,058.03 / $155,339.04
| Facility | | $11,651.17 | $65,058.03 | $155,339.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,572.12 / $11,651.17 / $17,493.89
| Professional | | $9,572.12 | $11,651.17 | $17,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,562.19 / $12,562.19 / $13,567.17
| Professional | | $12,562.19 | $12,562.19 | $13,567.17 |
- 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 / $24,366.96
| Professional | | $11,079.10 | $11,079.10 | $24,366.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,718.30 / $11,651.17 / $29,127.91
| Facility | | $6,718.30 | $11,651.17 | $29,127.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,718.30 / $6,718.30 / $6,718.30
| Professional | | $6,718.30 | $6,718.30 | $6,718.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,010.70 / $29,127.91 / $46,138.61
| Professional | | $17,010.70 | $29,127.91 | $46,138.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,621.71 / $10,406.57 / $16,036.20
| Professional | | $9,621.71 | $10,406.57 | $16,036.20 |