- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,424.06 / $43,062.50 / $62,009.90
| Facility | | $28,424.06 | $43,062.50 | $62,009.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,708.30 / $34,393.10
| Professional | | $28,424.06 | $28,708.30 | $34,393.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,645.43 / $43,627.76 / $87,605.95
| Facility | | $16,645.43 | $43,627.76 | $87,605.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,547.00 / $26,547.00 / $26,547.00
| Professional | | $26,547.00 | $26,547.00 | $26,547.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $28,424.06
| Facility | | $80.00 | $80.00 | $28,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,815.15 / $28,424.06 / $28,424.06
| Facility | | $26,815.15 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $28,424.06
| Professional | | $28,424.06 | $28,424.06 | $28,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,008.87 / $135,352.65 / $142,120.29
| Facility | | $36,008.87 | $135,352.65 | $142,120.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119,518.82 / $119,518.82 / $119,518.82
| Professional | | $119,518.82 | $119,518.82 | $119,518.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,630.50 / $28,424.06 / $35,396.00
| Facility | | $1,630.50 | $28,424.06 | $35,396.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,992.54 / $46,899.70
| Professional | | $28,424.06 | $28,992.54 | $46,899.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,482.90 / $31,266.46 / $56,421.45
| Professional | | $9,482.90 | $31,266.46 | $56,421.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.13 / $28,424.06 / $35,885.37
| Facility | | $1,658.13 | $28,424.06 | $35,885.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $28,424.06 / $33,838.16
| Professional | | $28,424.06 | $28,424.06 | $33,838.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,026.05 / $44,666.37 / $44,666.37
| Facility | | $33,026.05 | $44,666.37 | $44,666.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,424.06 / $30,129.50 / $31,641.95
| Professional | | $28,424.06 | $30,129.50 | $31,641.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,070.53 / $28,424.06 / $39,793.68
| Professional | | $27,070.53 | $28,424.06 | $39,793.68 |