- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,550.64 / $11,665.44 / $64,344.50
| Professional | | $8,550.64 | $11,665.44 | $64,344.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,847.37 / $13,847.37 / $13,847.37
| Facility | | $13,847.37 | $13,847.37 | $13,847.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $10,108.58 / $13,847.37
| Professional | | $10,108.58 | $10,108.58 | $13,847.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,426.29 / $40,627.18 / $52,988.02
| Professional | | $13,426.29 | $40,627.18 | $52,988.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,665.44 / $15,981.65 / $19,180.41
| Facility | | $11,665.44 | $15,981.65 | $19,180.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,261.38 / $18,029.59 / $20,139.43
| Professional | | $14,261.38 | $18,029.59 | $20,139.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,262.37 / $19,180.41 / $24,918.87
| Facility | | $17,262.37 | $19,180.41 | $24,918.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,237.15 / $15,237.15 / $15,237.15
| Professional | | $15,237.15 | $15,237.15 | $15,237.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,665.44 / $16,681.58 / $20,139.43
| Facility | | $11,665.44 | $16,681.58 | $20,139.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $16,795.04 / $21,098.45
| Professional | | $10,108.58 | $16,795.04 | $21,098.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,980.05 / $31,896.32 / $67,291.00
| Facility | | $15,980.05 | $31,896.32 | $67,291.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,495.15 / $21,098.45 / $21,098.45
| Professional | | $16,495.15 | $21,098.45 | $21,098.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,142.29 / $9,568.90 / $18,256.20
| Professional | | $9,142.29 | $9,568.90 | $18,256.20 |