- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $24,547.09 / $24,547.09
| Facility | | $21,379.62 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,882.50 / $21,379.62 / $25,703.96
| Professional | | $12,882.50 | $21,379.62 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $32,359.37
| Facility | | $16,218.10 | $16,218.10 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33,884.42 / $33,884.42 / $41,686.94
| Professional | | $33,884.42 | $33,884.42 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $29,512.09 / $77,624.71
| Facility | | $23,442.29 | $29,512.09 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $19,498.45 / $144,543.98
| Professional | | $11,748.98 | $19,498.45 | $144,543.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,302.68 / $31,622.78 / $31,622.78
| Professional | | $26,302.68 | $31,622.78 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,359.37 / $32,359.37 / $32,359.37
| Facility | | $32,359.37 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $52,480.75
| Professional | | $26,302.68 | $26,302.68 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,547.09 / $29,512.09 / $38,904.51
| Professional | | $24,547.09 | $29,512.09 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,481.54 / $18,620.87 / $30,902.95
| Professional | | $11,481.54 | $18,620.87 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Professional | | $28,183.83 | $28,183.83 | $28,183.83 |