- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,522.21 / $54,918.60 / $54,918.60
| Facility | | $14,522.21 | $54,918.60 | $54,918.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,522.21 / $14,522.21 / $17,123.20
| Professional | | $14,522.21 | $14,522.21 | $17,123.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,511.56 / $28,511.56 / $29,393.36
| Facility | | $28,511.56 | $28,511.56 | $29,393.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,014.63 / $22,016.11 / $22,238.49
| Professional | | $20,014.63 | $22,016.11 | $22,238.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,034.23 / $25,049.43 / $25,049.43
| Facility | | $13,034.23 | $25,049.43 | $25,049.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,034.23 / $25,049.43 / $38,626.75
| Professional | | $13,034.23 | $25,049.43 | $38,626.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,842.26 / $24,926.18 / $100,282.95
| Facility | | $11,842.26 | $24,926.18 | $100,282.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,669.98 / $13,875.42 / $18,934.68
| Professional | | $8,669.98 | $13,875.42 | $18,934.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,976.13 / $25,049.43 / $31,688.72
| Facility | | $24,976.13 | $25,049.43 | $31,688.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,515.61 / $29,603.87 / $51,605.92
| Professional | | $20,515.61 | $29,603.87 | $51,605.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,669.98 / $11,360.81 / $16,036.20
| Professional | | $8,669.98 | $11,360.81 | $16,036.20 |