- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,631.57 / $16,022.36 / $16,022.36
| Facility | | $15,631.57 | $16,022.36 | $16,022.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,631.57 / $16,022.36 / $16,608.54
| Professional | | $15,631.57 | $16,022.36 | $16,608.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,156.77 / $37,134.08 / $71,994.66
| Facility | | $15,156.77 | $37,134.08 | $71,994.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Facility | | $16,608.54 | $16,608.54 | $16,608.54 |
- 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
- $18,562.49 / $39,078.92 / $73,272.98
| Facility | | $18,562.49 | $39,078.92 | $73,272.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74,249.95 / $74,249.95 / $87,927.57
| Professional | | $74,249.95 | $74,249.95 | $87,927.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,583.64 / $19,539.46 / $34,868.16
| Facility | | $13,583.64 | $19,539.46 | $34,868.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,383.82 / $3,383.82 / $3,383.82
| Professional | | $3,383.82 | $3,383.82 | $3,383.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,631.57 / $16,608.54 / $26,544.36
| Facility | | $15,631.57 | $16,608.54 | $26,544.36 |
- 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 / $16,282.88
| Professional | | $16,282.88 | $16,282.88 | $16,282.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,282.88 / $18,562.49 / $25,059.36
| Professional | | $16,282.88 | $18,562.49 | $25,059.36 |