- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,433.02 / $7,618.00 / $14,101.30
| Facility | | $6,433.02 | $7,618.00 | $14,101.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,433.02 / $8,771.02 / $11,036.43
| Professional | | $6,433.02 | $8,771.02 | $11,036.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,505.43 / $17,855.55 / $35,010.87
| Facility | | $17,505.43 | $17,855.55 | $35,010.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,694.54 / $10,694.54 / $28,500.94
| Professional | | $10,694.54 | $10,694.54 | $28,500.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,563.64 / $14,584.56 / $14,584.56
| Facility | | $13,563.64 | $14,584.56 | $14,584.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,584.56 / $14,584.56 / $14,584.56
| Professional | | $14,584.56 | $14,584.56 | $14,584.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,562.99 / $12,562.99 / $12,562.99
| Facility | | $12,562.99 | $12,562.99 | $12,562.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,170.98 / $9,170.98 / $12,562.99
| Professional | | $9,170.98 | $9,170.98 | $12,562.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $17,505.43 / $39,387.24
| Facility | | $319.00 | $17,505.43 | $39,387.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,328.20 / $14,704.57 / $31,894.91
| Professional | | $10,328.20 | $14,704.57 | $31,894.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,524.36 / $11,182.13 / $14,584.56
| Professional | | $10,524.36 | $11,182.13 | $14,584.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $12,562.99 / $17,505.43
| Facility | | $597.00 | $12,562.99 | $17,505.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,170.98 / $10,429.24 / $26,083.11
| Professional | | $9,170.98 | $10,429.24 | $26,083.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,822.18 / $10,776.12 / $16,048.84
| Professional | | $5,822.18 | $10,776.12 | $16,048.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,524.36 / $10,524.36 / $13,451.15
| Facility | | $10,524.36 | $10,524.36 | $13,451.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,524.36 / $10,524.36 / $11,182.13
| Professional | | $10,524.36 | $10,524.36 | $11,182.13 |