- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,779.29 / $9,779.29 / $37,845.90
| Facility | | $9,779.29 | $9,779.29 | $37,845.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,569.67 / $10,354.54 / $13,343.73
| Professional | | $8,569.67 | $10,354.54 | $13,343.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,674.66 / $21,898.50 / $21,898.50
| Professional | | $16,674.66 | $21,898.50 | $21,898.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $21,898.50
| Facility | | $14,513.81 | $14,513.81 | $21,898.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $10,595.08 / $19,175.09
| Professional | | $10,595.08 | $10,595.08 | $19,175.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,146.62 / $21,898.50 / $41,607.15
| Professional | | $20,146.62 | $21,898.50 | $41,607.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,779.29 / $9,779.29 / $37,845.90
| Facility | | $9,779.29 | $9,779.29 | $37,845.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,569.67 / $10,738.05 / $17,798.30
| Professional | | $8,569.67 | $10,738.05 | $17,798.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,151.40 / $31,224.10 / $43,144.00
| Professional | | $27,151.40 | $31,224.10 | $43,144.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $21,898.50
| Facility | | $14,513.81 | $14,513.81 | $21,898.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $10,595.08 / $26,010.38
| Professional | | $10,595.08 | $10,595.08 | $26,010.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,656.51 / $20,843.32 / $20,843.32
| Facility | | $15,656.51 | $20,843.32 | $20,843.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,656.51 / $20,843.32 / $21,355.23
| Professional | | $15,656.51 | $20,843.32 | $21,355.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,874.11 / $11,894.01 / $18,208.18
| Professional | | $9,874.11 | $11,894.01 | $18,208.18 |