- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,126.25 / $13,866.63 / $14,421.30
| Facility | | $12,126.25 | $13,866.63 | $14,421.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,380.52 / $14,067.73 / $15,446.92
| Professional | | $12,380.52 | $14,067.73 | $15,446.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,852.92 / $21,852.92 / $21,852.92
| Professional | | $21,852.92 | $21,852.92 | $21,852.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,137.91 / $29,137.22 / $30,623.22
| Facility | | $18,137.91 | $29,137.22 | $30,623.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,628.09 / $15,571.41 / $17,411.83
| Professional | | $13,628.09 | $15,571.41 | $17,411.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,852.92 / $40,572.25 / $46,671.11
| Facility | | $21,852.92 | $40,572.25 | $46,671.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,680.36 / $36,225.23 / $48,076.41
| Professional | | $27,680.36 | $36,225.23 | $48,076.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,200.25 / $16,200.25 / $34,145.18
| Facility | | $16,200.25 | $16,200.25 | $34,145.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,826.18 / $16,200.25 / $138,969.38
| Professional | | $11,826.18 | $16,200.25 | $138,969.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,367.90 / $17,521.83 / $21,902.28
| Professional | | $14,367.90 | $17,521.83 | $21,902.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,690.83 / $14,536.25 / $19,793.02
| Professional | | $9,690.83 | $14,536.25 | $19,793.02 |