- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,847.39 / $14,847.39 / $15,005.46
| Facility | | $14,847.39 | $14,847.39 | $15,005.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,710.98 / $14,847.39 / $16,472.12
| Professional | | $13,710.98 | $14,847.39 | $16,472.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,151.96 / $28,151.96 / $29,897.38
| Facility | | $28,151.96 | $28,151.96 | $29,897.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,275.00 / $22,275.00 / $27,389.34
| Professional | | $22,275.00 | $22,275.00 | $27,389.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,423.63 / $15,776.54 / $19,244.50
| Professional | | $15,423.63 | $15,776.54 | $19,244.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,524.00 / $16,524.00 / $16,524.00
| Facility | | $16,524.00 | $16,524.00 | $16,524.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,062.52 / $12,062.52 / $16,524.00
| Professional | | $12,062.52 | $12,062.52 | $16,524.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,706.37 / $25,336.76 / $33,782.35
| Professional | | $19,706.37 | $25,336.76 | $33,782.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,847.39 / $18,876.68 / $28,998.81
| Facility | | $14,847.39 | $18,876.68 | $28,998.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,352.23 / $36,977.75 / $46,892.07
| Professional | | $16,352.23 | $36,977.75 | $46,892.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.39 / $21,246.06 / $31,951.70
| Facility | | $404.39 | $21,246.06 | $31,951.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.39 / $21,246.06 / $31,951.70
| Professional | | $404.39 | $21,246.06 | $31,951.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,985.48 / $14,044.70 / $21,642.46
| Professional | | $12,985.48 | $14,044.70 | $21,642.46 |