- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,251.16 / $7,402.65 / $13,702.70
| Facility | | $6,251.16 | $7,402.65 | $13,702.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,251.16 / $8,194.11 / $10,724.44
| Professional | | $6,251.16 | $8,194.11 | $10,724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,010.57 / $17,350.78 / $34,021.14
| Facility | | $17,010.57 | $17,350.78 | $34,021.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,344.35 / $10,344.35 / $27,567.69
| Professional | | $10,344.35 | $10,344.35 | $27,567.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,180.21 / $14,172.27 / $14,172.27
| Facility | | $13,180.21 | $14,172.27 | $14,172.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,172.27 / $14,172.27 / $14,172.27
| Professional | | $14,172.27 | $14,172.27 | $14,172.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,736.82 / $11,736.82 / $11,736.82
| Facility | | $11,736.82 | $11,736.82 | $11,736.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $8,567.87 / $11,736.82
| Professional | | $8,567.87 | $8,567.87 | $11,736.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $17,010.57 / $38,273.78
| Facility | | $319.00 | $17,010.57 | $38,273.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,036.24 / $13,877.94 / $30,993.26
| Professional | | $10,036.24 | $13,877.94 | $30,993.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,226.84 / $10,866.02 / $14,172.27
| Professional | | $10,226.84 | $10,866.02 | $14,172.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $11,736.82 / $17,010.57
| Facility | | $597.00 | $11,736.82 | $17,010.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $10,134.42 / $25,345.75
| Professional | | $8,567.87 | $10,134.42 | $25,345.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,657.59 / $10,206.34 / $15,184.25
| Professional | | $5,657.59 | $10,206.34 | $15,184.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,226.84 / $10,226.84 / $10,627.59
| Facility | | $10,226.84 | $10,226.84 | $10,627.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,226.84 / $10,226.84 / $10,866.02
| Professional | | $10,226.84 | $10,226.84 | $10,866.02 |