- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $17,782.79 / $17,782.79
| Facility | | $15,488.17 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $15,488.17 / $18,197.01
| Professional | | $9,120.11 | $15,488.17 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $12,882.50 / $23,442.29
| Facility | | $12,882.50 | $12,882.50 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $30,902.95
| Professional | | $24,547.09 | $24,547.09 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,595.87 / $22,387.21 / $57,543.99
| Facility | | $16,595.87 | $22,387.21 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $14,125.38 / $107,151.93
| Professional | | $8,511.38 | $14,125.38 | $107,151.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $22,908.68 / $23,442.29
| Professional | | $19,498.45 | $22,908.68 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $23,442.29 / $23,442.29
| Facility | | $23,442.29 | $23,442.29 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $38,018.94
| Professional | | $19,498.45 | $19,498.45 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,782.79 / $21,379.62 / $28,183.83
| Professional | | $17,782.79 | $21,379.62 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $13,489.63 / $22,387.21
| Professional | | $8,511.38 | $13,489.63 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,892.96 / $20,892.96 / $20,892.96
| Professional | | $20,892.96 | $20,892.96 | $20,892.96 |