- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,481.49 / $17,929.68 / $17,929.68
| Facility | | $16,481.49 | $17,929.68 | $17,929.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,221.77 / $11,519.83 / $17,282.16
| Professional | | $8,221.77 | $11,519.83 | $17,282.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,847.37 / $13,847.37 / $22,472.43
| Facility | | $13,847.37 | $13,847.37 | $22,472.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,847.37 / $24,816.00 / $31,020.00
| Professional | | $13,847.37 | $24,816.00 | $31,020.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,540.59 / $21,011.42 / $22,256.26
| Professional | | $18,540.59 | $21,011.42 | $22,256.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,028.21 / $26,558.32 / $99,695.00
| Facility | | $13,028.21 | $26,558.32 | $99,695.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,766.60 / $13,049.96 / $27,912.61
| Professional | | $9,766.60 | $13,049.96 | $27,912.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,406.67 / $22,472.43 / $29,137.94
| Facility | | $22,406.67 | $22,472.43 | $29,137.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,310.20 / $26,558.32 / $42,944.33
| Professional | | $19,310.20 | $26,558.32 | $42,944.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,766.60 / $10,840.95 / $24,037.63
| Professional | | $9,766.60 | $10,840.95 | $24,037.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,020.89 / $20,020.89 / $20,020.89
| Facility | | $20,020.89 | $20,020.89 | $20,020.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,816.50 / $20,020.89 / $20,020.89
| Professional | | $15,816.50 | $20,020.89 | $20,020.89 |