- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $48,977.88 / $48,977.88
| Facility | | $12,589.25 | $48,977.88 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,302.69 / $14,454.40 / $24,547.09
| Professional | | $12,302.69 | $14,454.40 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,183.83 / $28,183.83 / $28,183.83
| Professional | | $28,183.83 | $28,183.83 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $28,840.32
| Facility | | $16,218.10 | $16,218.10 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,748.98 / $11,748.98 / $16,982.44
| Professional | | $11,748.98 | $11,748.98 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,915.35 / $38,018.94 / $54,954.09
| Professional | | $26,915.35 | $38,018.94 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,840.32 / $28,840.32 / $28,840.32
| Facility | | $28,840.32 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,378.01 / $20,417.38 / $28,840.32
| Professional | | $17,378.01 | $20,417.38 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $19,952.62
| Professional | | $19,054.61 | $19,054.61 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $48,977.88
| Facility | | $12,589.25 | $12,589.25 | $48,977.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,302.69 / $14,454.40 / $25,703.96
| Professional | | $12,302.69 | $14,454.40 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $45,708.82 / $45,708.82
| Facility | | $45,708.82 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $38,904.51 / $56,234.13
| Professional | | $0.60 | $38,904.51 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $20,417.38 / $26,915.35
| Facility | | $20,417.38 | $20,417.38 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,417.38 / $20,417.38 / $27,542.29
| Professional | | $20,417.38 | $20,417.38 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $35,481.34 / $42,657.95
| Facility | | $11,748.98 | $35,481.34 | $42,657.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,882.50 / $15,488.17 / $25,703.96
| Professional | | $12,882.50 | $15,488.17 | $25,703.96 |