- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,047.40 / $9,529.76 / $17,640.09
| Facility | | $8,047.40 | $9,529.76 | $17,640.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,047.40 / $9,660.77 / $13,806.06
| Professional | | $8,047.40 | $9,660.77 | $13,806.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,898.50 / $22,336.47 / $43,797.00
| Facility | | $21,898.50 | $22,336.47 | $43,797.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,489.26 / $12,489.26 / $34,595.25
| Professional | | $12,489.26 | $12,489.26 | $34,595.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,967.49 / $18,244.61 / $18,244.61
| Facility | | $16,967.49 | $18,244.61 | $18,244.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,244.61 / $18,244.61 / $18,244.61
| Professional | | $18,244.61 | $18,244.61 | $18,244.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $14,513.81
| Facility | | $14,513.81 | $14,513.81 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $10,595.08 / $14,513.81
| Professional | | $10,595.08 | $10,595.08 | $14,513.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $21,898.50 / $49,271.63
| Facility | | $319.00 | $21,898.50 | $49,271.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,920.12 / $16,423.88 / $39,899.07
| Professional | | $12,920.12 | $16,423.88 | $39,899.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,165.48 / $13,988.32 / $18,244.61
| Professional | | $13,165.48 | $13,988.32 | $18,244.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $14,513.81 / $21,898.50
| Facility | | $597.00 | $14,513.81 | $21,898.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $13,534.34 / $32,512.97
| Professional | | $10,595.08 | $13,534.34 | $32,512.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,283.28 / $13,213.37 / $18,408.84
| Professional | | $7,283.28 | $13,213.37 | $18,408.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,705.58 / $13,165.48 / $13,165.48
| Facility | | $11,705.58 | $13,165.48 | $13,165.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,165.48 / $13,165.48 / $13,988.32
| Professional | | $13,165.48 | $13,165.48 | $13,988.32 |