- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,789.61 / $16,789.61 / $34,074.30
| Facility | | $16,789.61 | $16,789.61 | $34,074.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,091.35 / $16,789.61 / $16,789.61
| Professional | | $10,091.35 | $16,789.61 | $16,789.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,085.83 / $21,703.00 / $41,208.57
| Facility | | $18,085.83 | $21,703.00 | $41,208.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,704.80 / $16,918.41 / $16,918.41
| Professional | | $15,704.80 | $16,918.41 | $16,918.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $14,513.81
| Facility | | $14,513.81 | $14,513.81 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $14,513.81 / $26,010.38
| Professional | | $10,595.08 | $14,513.81 | $26,010.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,455.32 / $16,789.61 / $25,088.38
| Facility | | $6,455.32 | $16,789.61 | $25,088.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,826.18 / $15,826.18 / $15,826.18
| Professional | | $15,826.18 | $15,826.18 | $15,826.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,278.20 / $26,278.20 / $40,403.90
| Professional | | $26,278.20 | $26,278.20 | $40,403.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,646.37 / $11,253.89 / $16,318.14
| Professional | | $8,646.37 | $11,253.89 | $16,318.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,693.01 / $104,478.94 / $104,478.94
| Facility | | $37,693.01 | $104,478.94 | $104,478.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112,957.80 / $164,238.75 / $164,238.75
| Professional | | $112,957.80 | $164,238.75 | $164,238.75 |