- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,028.21 / $13,028.21 / $13,028.21
| Facility | | $13,028.21 | $13,028.21 | $13,028.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,028.21 / $13,028.21 / $15,361.62
| Professional | | $13,028.21 | $13,028.21 | $15,361.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,955.59 / $19,751.15 / $19,950.66
| Professional | | $17,955.59 | $19,751.15 | $19,950.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,847.37 / $22,472.43 / $22,472.43
| Facility | | $13,847.37 | $22,472.43 | $22,472.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,847.37 / $22,472.43 / $34,652.94
| Professional | | $13,847.37 | $22,472.43 | $34,652.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,724.54 / $22,361.85 / $99,695.00
| Facility | | $10,724.54 | $22,361.85 | $99,695.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,778.04 / $12,644.72 / $16,986.74
| Professional | | $7,778.04 | $12,644.72 | $16,986.74 |
- 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
- $18,405.05 / $26,745.21 / $46,296.86
| Professional | | $18,405.05 | $26,745.21 | $46,296.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,778.04 / $10,192.04 / $14,745.38
| Professional | | $7,778.04 | $10,192.04 | $14,745.38 |