- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,302.69 / $14,791.08 / $57,543.99
| Professional | | $12,302.69 | $14,791.08 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,877.62 / $22,908.68 / $26,915.35
| Professional | | $21,877.62 | $22,908.68 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $16,982.44 / $35,481.34
| Facility | | $7,413.10 | $16,982.44 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,877.62 / $28,183.83 / $53,703.18
| Professional | | $21,877.62 | $28,183.83 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $16,218.10
| Facility | | $16,218.10 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $16,218.10
| Professional | | $11,748.98 | $11,748.98 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $19,054.61 / $58,884.37
| Facility | | $8,317.64 | $19,054.61 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $12,882.50 / $144,543.98
| Professional | | $11,748.98 | $12,882.50 | $144,543.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $19,952.62 / $22,387.21
| Facility | | $10,000.00 | $19,952.62 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $12,882.50 / $19,498.45
| Professional | | $11,748.98 | $12,882.50 | $19,498.45 |