- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,390.08 / $27,539.80 / $45,228.00
| Facility | | $22,390.08 | $27,539.80 | $45,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,390.08 / $22,949.83 / $26,588.22
| Professional | | $22,390.08 | $22,949.83 | $26,588.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,671.20 / $54,611.42 / $103,371.62
| Facility | | $21,671.20 | $54,611.42 | $103,371.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,145.14 / $24,145.14 / $24,145.14
| Professional | | $24,145.14 | $24,145.14 | $24,145.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,789.46 / $23,789.46 / $23,789.46
| Facility | | $23,789.46 | $23,789.46 | $23,789.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,789.46 / $23,789.46 / $23,789.46
| Professional | | $23,789.46 | $23,789.46 | $23,789.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,588.22 / $121,142.10 / $121,142.10
| Facility | | $26,588.22 | $121,142.10 | $121,142.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103,405.50 / $106,352.88 / $125,944.20
| Professional | | $103,405.50 | $106,352.88 | $125,944.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,563.56 / $22,949.83 / $32,017.81
| Facility | | $2,563.56 | $22,949.83 | $32,017.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,078.89 / $3,980.88 / $20,990.70
| Professional | | $2,078.89 | $3,980.88 | $20,990.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $27.40 / $3,094.00
| Professional | | $27.40 | $27.40 | $3,094.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,580.37 / $23,229.71 / $32,519.35
| Facility | | $2,580.37 | $23,229.71 | $32,519.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,789.46 / $23,789.46 / $27,987.60
| Professional | | $23,789.46 | $23,789.46 | $27,987.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,323.00 / $24,722.38 / $25,963.40
| Professional | | $23,323.00 | $24,722.38 | $25,963.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,323.00 / $23,323.00 / $32,652.20
| Professional | | $23,323.00 | $23,323.00 | $32,652.20 |