- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,431.61 / $13,431.61 / $27,259.30
| Facility | | $13,431.61 | $13,431.61 | $27,259.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,584.52 / $13,431.61 / $13,431.61
| Professional | | $8,584.52 | $13,431.61 | $13,431.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,468.58 / $17,362.30 / $32,966.66
| Facility | | $14,468.58 | $17,362.30 | $32,966.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,286.33 / $13,534.65 / $13,534.65
| Professional | | $10,286.33 | $13,534.65 | $13,534.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,162.99 / $12,562.99 / $12,562.99
| Facility | | $11,162.99 | $12,562.99 | $12,562.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,170.98 / $12,562.99 / $22,514.25
| Professional | | $9,170.98 | $12,562.99 | $22,514.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,638.05 / $13,431.61 / $21,226.35
| Facility | | $5,638.05 | $13,431.61 | $21,226.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,147.00 / $10,147.00 / $12,661.00
| Professional | | $10,147.00 | $10,147.00 | $12,661.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,006.50 / $21,006.50 / $32,298.50
| Professional | | $21,006.50 | $21,006.50 | $32,298.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,917.06 / $9,041.21 / $14,124.26
| Professional | | $6,917.06 | $9,041.21 | $14,124.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,735.91 / $90,961.51 / $90,961.51
| Facility | | $32,735.91 | $90,961.51 | $90,961.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114,114.63 / $114,114.63 / $131,290.79
| Professional | | $114,114.63 | $114,114.63 | $131,290.79 |