- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,482.23 / $15,631.60 / $16,608.54
| Facility | | $13,482.23 | $15,631.60 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,482.23 / $16,217.75 / $16,608.54
| Professional | | $13,482.23 | $16,217.75 | $16,608.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,451.93 / $3,451.93 / $4,314.91
| Facility | | $3,451.93 | $3,451.93 | $4,314.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,282.88 / $16,282.88 / $16,282.88
| Professional | | $16,282.88 | $16,282.88 | $16,282.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,282.88 / $16,282.88 / $16,282.88
| Facility | | $16,282.88 | $16,282.88 | $16,282.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,282.88 / $16,282.88 / $16,282.88
| Professional | | $16,282.88 | $16,282.88 | $16,282.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $17,620.00 / $17,620.00
| Facility | | $16,608.54 | $17,620.00 | $17,620.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Professional | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $26,905.83
| Facility | | $16,608.54 | $16,608.54 | $26,905.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,117.26 / $16,608.54 / $16,608.54
| Professional | | $14,117.26 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,834.59 / $7,834.59 / $7,834.59
| Professional | | $7,834.59 | $7,834.59 | $7,834.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $17,106.80 / $17,620.00
| Facility | | $597.00 | $17,106.80 | $17,620.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Professional | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,282.88 / $16,282.88 / $21,979.28
| Professional | | $16,282.88 | $16,282.88 | $21,979.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,834.59 / $7,834.59 / $7,834.59
| Professional | | $7,834.59 | $7,834.59 | $7,834.59 |