- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,722.50 / $25,967.46 / $72,688.50
| Facility | | $2,722.50 | $25,967.46 | $72,688.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,451.89 / $17,102.52 / $17,102.52
| Professional | | $10,451.89 | $17,102.52 | $17,102.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,933.04 / $34,084.99 / $41,976.59
| Facility | | $20,933.04 | $34,084.99 | $41,976.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,997.49 / $17,233.73 / $18,382.64
| Professional | | $15,997.49 | $17,233.73 | $18,382.64 |
- 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 / $13,034.23 / $27,402.38
| Professional | | $11,079.10 | $13,034.23 | $27,402.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,718.30 / $17,102.52 / $25,876.61
| Facility | | $6,718.30 | $17,102.52 | $25,876.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,854.00 / $12,854.00 / $16,122.00
| Professional | | $12,854.00 | $12,854.00 | $16,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,600.10 / $27,600.10 / $42,436.50
| Professional | | $27,600.10 | $27,600.10 | $42,436.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,807.52 / $11,463.62 / $17,984.48
| Professional | | $8,807.52 | $11,463.62 | $17,984.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,710.28 / $112,458.86 / $112,458.86
| Facility | | $39,710.28 | $112,458.86 | $112,458.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116,045.60 / $116,045.60 / $172,500.69
| Professional | | $116,045.60 | $116,045.60 | $172,500.69 |