- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.87 / $13,318.57 / $63,182.40
| Professional | | $9,772.87 | $13,318.57 | $63,182.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $14,513.81
| Facility | | $14,513.81 | $14,513.81 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $10,595.08 / $14,513.81
| Professional | | $10,595.08 | $10,595.08 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,328.95 / $42,453.86 / $55,370.45
| Professional | | $15,328.95 | $42,453.86 | $55,370.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,318.57 / $18,246.43 / $21,898.50
| Facility | | $13,318.57 | $18,246.43 | $21,898.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,282.37 / $20,584.59 / $22,993.43
| Professional | | $16,282.37 | $20,584.59 | $22,993.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,708.65 / $21,898.50 / $24,950.52
| Facility | | $19,708.65 | $21,898.50 | $24,950.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,318.57 / $18,807.83 / $22,993.43
| Facility | | $13,318.57 | $18,807.83 | $22,993.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $19,175.09 / $24,088.35
| Professional | | $10,595.08 | $19,175.09 | $24,088.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,244.61 / $36,416.37 / $76,826.92
| Facility | | $18,244.61 | $36,416.37 | $76,826.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,832.71 / $24,088.35 / $24,088.35
| Professional | | $18,832.71 | $24,088.35 | $24,088.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,553.42 / $9,999.21 / $19,077.20
| Professional | | $9,553.42 | $9,999.21 | $19,077.20 |