- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,406.86 / $10,406.86 / $26,674.00
| Facility | | $10,406.86 | $10,406.86 | $26,674.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,115.26 / $10,406.86 / $14,271.25
| Professional | | $10,115.26 | $10,406.86 | $14,271.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,013.14 / $23,444.58 / $60,742.76
| Facility | | $20,013.14 | $23,444.58 | $60,742.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,303.16 / $11,314.46 / $27,707.22
| Professional | | $11,303.16 | $11,314.46 | $27,707.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,116.25 / $18,116.25 / $18,116.25
| Professional | | $18,116.25 | $18,116.25 | $18,116.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,661.72 / $21,313.25 / $28,772.89
| Facility | | $15,661.72 | $21,313.25 | $28,772.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,853.61 / $19,181.93 / $45,635.93
| Professional | | $13,853.61 | $19,181.93 | $45,635.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,752.32 / $12,752.32 / $24,471.43
| Facility | | $12,752.32 | $12,752.32 | $24,471.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,309.19 / $9,309.19 / $12,813.64
| Professional | | $9,309.19 | $9,309.19 | $12,813.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,752.32 / $12,752.32 / $12,752.32
| Facility | | $12,752.32 | $12,752.32 | $12,752.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,309.19 / $12,752.32 / $12,752.32
| Professional | | $9,309.19 | $12,752.32 | $12,752.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,088.63 / $10,632.95 / $14,890.75
| Professional | | $7,088.63 | $10,632.95 | $14,890.75 |