- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,818.25 / $10,646.73 / $54,415.80
| Professional | | $7,818.25 | $10,646.73 | $54,415.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,562.99 / $12,562.99 / $12,562.99
| Facility | | $12,562.99 | $12,562.99 | $12,562.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,170.98 / $9,170.98 / $12,562.99
| Professional | | $9,170.98 | $9,170.98 | $12,562.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,253.81 / $37,078.94 / $48,360.23
| Professional | | $12,253.81 | $37,078.94 | $48,360.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,646.73 / $14,586.02 / $17,505.43
| Facility | | $10,646.73 | $14,586.02 | $17,505.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,015.97 / $16,455.11 / $18,380.71
| Professional | | $13,015.97 | $16,455.11 | $18,380.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,754.90 / $17,505.43 / $22,757.07
| Facility | | $15,754.90 | $17,505.43 | $22,757.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,906.54 / $13,906.54 / $13,906.54
| Professional | | $13,906.54 | $13,906.54 | $13,906.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,646.73 / $15,224.82 / $18,380.71
| Facility | | $10,646.73 | $15,224.82 | $18,380.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,170.98 / $15,328.38 / $19,255.98
| Professional | | $9,170.98 | $15,328.38 | $19,255.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,584.56 / $29,110.90 / $61,414.69
| Facility | | $14,584.56 | $29,110.90 | $61,414.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,054.68 / $19,255.98 / $19,255.98
| Professional | | $15,054.68 | $19,255.98 | $19,255.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,343.92 / $8,733.27 / $16,661.93
| Professional | | $8,343.92 | $8,733.27 | $16,661.93 |