- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,046.94 / $12,597.79 / $59,763.10
| Professional | | $9,046.94 | $12,597.79 | $59,763.10 |
- 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 / $9,309.19 / $12,752.32
| Professional | | $9,309.19 | $9,309.19 | $12,752.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,499.37 / $39,863.00 / $51,991.31
| Professional | | $14,499.37 | $39,863.00 | $51,991.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,597.79 / $18,154.27 / $20,713.39
| Facility | | $12,597.79 | $18,154.27 | $20,713.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,248.73 / $19,677.72 / $21,749.06
| Professional | | $15,248.73 | $19,677.72 | $21,749.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,227.91 / $20,713.39 / $23,414.46
| Facility | | $20,227.91 | $20,713.39 | $23,414.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,454.98 / $16,454.98 / $16,454.98
| Professional | | $16,454.98 | $16,454.98 | $16,454.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,597.79 / $18,137.37 / $21,749.06
| Facility | | $12,597.79 | $18,137.37 | $21,749.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,309.19 / $18,137.37 / $22,784.73
| Professional | | $9,309.19 | $18,137.37 | $22,784.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,257.25 / $34,445.60 / $72,669.19
| Facility | | $17,257.25 | $34,445.60 | $72,669.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,813.52 / $22,784.73 / $22,784.73
| Professional | | $17,813.52 | $22,784.73 | $22,784.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,934.45 / $9,388.91 / $17,912.82
| Professional | | $8,934.45 | $9,388.91 | $17,912.82 |