- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,343.64 / $27,966.06 / $33,904.71
| Facility | | $12,343.64 | $27,966.06 | $33,904.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,984.53 / $12,343.64 / $12,528.28
| Professional | | $10,984.53 | $12,343.64 | $12,528.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,562.19 / $12,562.19 / $16,220.72
| Professional | | $12,562.19 | $12,562.19 | $16,220.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,293.91 / $15,293.91 / $15,293.91
| Professional | | $15,293.91 | $15,293.91 | $15,293.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,034.23 / $13,034.23 / $13,034.23
| Facility | | $13,034.23 | $13,034.23 | $13,034.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,079.10 / $11,079.10 / $13,034.23
| Professional | | $11,079.10 | $11,079.10 | $13,034.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,383.24 / $21,064.17 / $28,085.56
| Professional | | $16,383.24 | $21,064.17 | $28,085.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,718.30 / $14,394.27 / $26,156.79
| Facility | | $6,718.30 | $14,394.27 | $26,156.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,854.00 / $30,742.09 / $38,984.54
| Professional | | $12,854.00 | $30,742.09 | $38,984.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,822.71 / $17,588.72 / $25,929.20
| Facility | | $12,822.71 | $17,588.72 | $25,929.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,822.71 / $17,588.72 / $25,929.20
| Professional | | $12,822.71 | $17,588.72 | $25,929.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,553.23 / $11,676.31 / $16,751.16
| Professional | | $10,553.23 | $11,676.31 | $16,751.16 |