- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,689.84 / $14,689.84 / $29,812.90
| Facility | | $14,689.84 | $14,689.84 | $29,812.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,477.42 / $14,689.84 / $14,689.84
| Professional | | $9,477.42 | $14,689.84 | $14,689.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,823.98 / $18,988.77 / $36,054.87
| Facility | | $15,823.98 | $18,988.77 | $36,054.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,249.93 / $14,802.54 / $14,802.54
| Professional | | $11,249.93 | $14,802.54 | $14,802.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,208.72 / $13,847.37 / $13,847.37
| Facility | | $12,208.72 | $13,847.37 | $13,847.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $13,847.37 / $24,816.00
| Professional | | $10,108.58 | $13,847.37 | $24,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,177.51 / $14,689.84 / $23,177.19
| Facility | | $6,177.51 | $14,689.84 | $23,177.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,098.00 / $11,098.00 / $13,847.00
| Professional | | $11,098.00 | $11,098.00 | $13,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,016.50 / $23,016.50 / $35,388.90
| Professional | | $23,016.50 | $23,016.50 | $35,388.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,974.08 / $9,888.19 / $15,173.07
| Professional | | $7,974.08 | $9,888.19 | $15,173.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,962.23 / $105,930.89 / $105,930.89
| Facility | | $35,962.23 | $105,930.89 | $105,930.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114,727.09 / $114,727.09 / $143,853.07
| Professional | | $114,727.09 | $114,727.09 | $143,853.07 |