- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,623.28 / $17,203.13 / $81,610.60
| Professional | | $12,623.28 | $17,203.13 | $81,610.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,200.25 / $16,200.25 / $16,200.25
| Facility | | $16,200.25 | $16,200.25 | $16,200.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,826.18 / $11,826.18 / $16,200.25
| Professional | | $11,826.18 | $11,826.18 | $16,200.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,799.86 / $54,915.31 / $71,623.31
| Professional | | $19,799.86 | $54,915.31 | $71,623.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,203.13 / $23,568.29 / $28,285.52
| Facility | | $17,203.13 | $23,568.29 | $28,285.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,031.38 / $26,588.39 / $29,699.80
| Professional | | $21,031.38 | $26,588.39 | $29,699.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,456.97 / $28,285.52 / $32,205.05
| Facility | | $25,456.97 | $28,285.52 | $32,205.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,200.25 / $24,293.42 / $29,699.80
| Facility | | $16,200.25 | $24,293.42 | $29,699.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,826.18 / $24,767.79 / $31,114.07
| Professional | | $11,826.18 | $24,767.79 | $31,114.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,565.93 / $47,037.78 / $99,234.63
| Facility | | $23,565.93 | $47,037.78 | $99,234.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,325.55 / $31,114.07 / $31,114.07
| Professional | | $24,325.55 | $31,114.07 | $31,114.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,482.01 / $41,482.01 / $55,309.36
| Facility | | $41,482.01 | $41,482.01 | $55,309.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,357.68 / $12,934.33 / $24,677.01
| Professional | | $12,357.68 | $12,934.33 | $24,677.01 |