- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,987.08 / $7,987.08 / $30,910.00
| Facility | | $7,987.08 | $7,987.08 | $30,910.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,656.85 / $8,456.91 / $10,443.00
| Professional | | $6,656.85 | $8,456.91 | $10,443.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,618.76 / $17,885.25 / $17,885.25
| Professional | | $13,618.76 | $17,885.25 | $17,885.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,736.82 / $11,736.82 / $17,010.57
| Facility | | $11,736.82 | $11,736.82 | $17,010.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $8,567.87 / $14,895.05
| Professional | | $8,567.87 | $8,567.87 | $14,895.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,649.72 / $17,010.57 / $32,320.08
| Professional | | $15,649.72 | $17,010.57 | $32,320.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,987.08 / $7,987.08 / $30,910.00
| Facility | | $7,987.08 | $7,987.08 | $30,910.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,656.85 / $8,456.91 / $11,650.66
| Professional | | $6,656.85 | $8,456.91 | $11,650.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,521.90 / $23,200.10 / $33,513.90
| Professional | | $11,521.90 | $23,200.10 | $33,513.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,736.82 / $11,736.82 / $17,010.57
| Facility | | $11,736.82 | $11,736.82 | $17,010.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $8,567.87 / $21,033.75
| Professional | | $8,567.87 | $8,567.87 | $21,033.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,546.50 / $8,546.50 / $17,023.45
| Facility | | $8,546.50 | $8,546.50 | $17,023.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,546.50 / $17,023.45 / $17,269.25
| Professional | | $8,546.50 | $17,023.45 | $17,269.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,365.29 / $10,731.15 / $16,129.03
| Professional | | $8,365.29 | $10,731.15 | $16,129.03 |