- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,503.00 / $10,723.09 / $51,380.40
| Professional | | $7,503.00 | $10,723.09 | $51,380.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,736.82 / $11,736.82 / $11,736.82
| Facility | | $11,736.82 | $11,736.82 | $11,736.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $8,567.87 / $11,736.82
| Professional | | $8,567.87 | $8,567.87 | $11,736.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,341.70 / $36,030.67 / $46,993.02
| Professional | | $12,341.70 | $36,030.67 | $46,993.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,723.09 / $14,690.63 / $17,631.00
| Facility | | $10,723.09 | $14,690.63 | $17,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,109.33 / $16,573.14 / $18,512.55
| Professional | | $13,109.33 | $16,573.14 | $18,512.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,867.90 / $17,631.00 / $22,920.30
| Facility | | $15,867.90 | $17,631.00 | $22,920.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,335.09 / $19,335.09 / $19,335.09
| Professional | | $19,335.09 | $19,335.09 | $19,335.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,723.09 / $15,196.95 / $18,512.55
| Facility | | $10,723.09 | $15,196.95 | $18,512.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $15,438.32 / $19,394.09
| Professional | | $8,567.87 | $15,438.32 | $19,394.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,689.17 / $29,319.70 / $61,855.17
| Facility | | $14,689.17 | $29,319.70 | $61,855.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,162.66 / $19,394.09 / $19,394.09
| Professional | | $15,162.66 | $19,394.09 | $19,394.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,108.05 / $8,486.39 / $16,190.92
| Professional | | $8,108.05 | $8,486.39 | $16,190.92 |