- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $18,620.87 / $18,620.87
| Facility | | $16,595.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $16,595.87 / $19,952.62
| Professional | | $9,772.37 | $16,595.87 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $25,118.86
| Facility | | $14,454.40 | $14,454.40 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $32,359.37
| Professional | | $26,302.68 | $26,302.68 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $22,908.68 / $60,255.96
| Facility | | $18,197.01 | $22,908.68 | $60,255.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $15,135.61 / $112,201.85
| Professional | | $9,120.11 | $15,135.61 | $112,201.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $24,547.09 / $24,547.09
| Professional | | $20,417.38 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $25,118.86
| Facility | | $25,118.86 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $20,417.38 / $40,738.03
| Professional | | $20,417.38 | $20,417.38 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $22,908.68 / $30,199.52
| Professional | | $19,054.61 | $22,908.68 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $23,988.33
| Professional | | $8,912.51 | $14,454.40 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,877.62 / $21,877.62 / $21,877.62
| Professional | | $21,877.62 | $21,877.62 | $21,877.62 |