- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,147.37 / $10,147.37 / $10,959.17
| Facility | | $10,147.37 | $10,147.37 | $10,959.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,477.42 / $10,959.17 / $20,294.75
| Professional | | $9,477.42 | $10,959.17 | $20,294.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,800.44 / $13,800.44 / $13,800.44
| Professional | | $13,800.44 | $13,800.44 | $13,800.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,177.19 / $23,177.19 / $23,177.19
| Facility | | $23,177.19 | $23,177.19 | $23,177.19 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $99,695.00 / $105,930.89 / $105,930.89
| Facility | | $99,695.00 | $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 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,177.51 / $16,152.27 / $23,177.19
| Facility | | $6,177.51 | $16,152.27 | $23,177.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,247.23 / $19,599.79 / $23,177.19
| Professional | | $6,247.23 | $19,599.79 | $23,177.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,177.51 / $15,486.36 / $23,177.19
| Facility | | $6,177.51 | $15,486.36 | $23,177.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $10,108.58 / $14,262.79
| Professional | | $10,108.58 | $10,108.58 | $14,262.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,974.08 / $11,796.31 / $14,745.38
| Professional | | $7,974.08 | $11,796.31 | $14,745.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,606.23 / $11,663.83 / $23,177.19
| Professional | | $11,606.23 | $11,663.83 | $23,177.19 |