- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,549.30 / $11,549.30 / $11,672.26
| Facility | | $11,549.30 | $11,549.30 | $11,672.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,665.35 / $11,549.30 / $12,037.88
| Professional | | $10,665.35 | $11,549.30 | $12,037.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,898.50 / $21,898.50 / $23,256.21
| Facility | | $21,898.50 | $21,898.50 | $23,256.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,489.26 / $12,489.26 / $15,612.82
| Professional | | $12,489.26 | $12,489.26 | $15,612.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,168.77 / $13,168.77 / $14,969.68
| Professional | | $13,168.77 | $13,168.77 | $14,969.68 |
- 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 / $19,708.65 / $26,278.20
| Professional | | $15,328.95 | $19,708.65 | $26,278.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,455.32 / $13,467.97 / $24,570.44
| Facility | | $6,455.32 | $13,467.97 | $24,570.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,826.18 / $28,763.78 / $36,475.81
| Professional | | $15,826.18 | $28,763.78 | $36,475.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,397.66 / $16,440.39 / $23,938.75
| Facility | | $11,397.66 | $16,440.39 | $23,938.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,397.66 / $16,440.39 / $23,938.75
| Professional | | $11,397.66 | $16,440.39 | $23,938.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,874.11 / $10,924.91 / $16,456.84
| Professional | | $9,874.11 | $10,924.91 | $16,456.84 |