- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $11,220.18 / $19,952.62
| Professional | | $9,549.93 | $11,220.18 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $21,379.62 / $104,712.85
| Facility | | $20,892.96 | $21,379.62 | $104,712.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $16,595.87 / $22,387.21
| Professional | | $10,000.00 | $16,595.87 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $28,840.32 / $38,018.94
| Facility | | $24,547.09 | $28,840.32 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $19,498.45 / $19,498.45
| Professional | | $15,488.17 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Facility | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $14,454.40
| Professional | | $10,715.19 | $10,715.19 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,054.61 / $19,054.61 / $28,840.32
| Professional | | $19,054.61 | $19,054.61 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $15,848.93
| Professional | | $15,848.93 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $21,379.62 / $104,712.85
| Facility | | $20,892.96 | $21,379.62 | $104,712.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $16,982.44 / $24,547.09
| Professional | | $10,000.00 | $16,982.44 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $15,135.61 / $27,542.29
| Facility | | $15.85 | $15,135.61 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $15,135.61 / $19,054.61
| Professional | | $9,332.54 | $15,135.61 | $19,054.61 |