- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $10,715.19
| Facility | | $9,772.37 | $9,772.37 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,964.78 / $19,054.61
| Professional | | $9,549.93 | $10,964.78 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Professional | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $22,908.68 / $22,908.68
| Facility | | $79.43 | $22,908.68 | $22,908.68 |
- 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
- $104,712.85 / $104,712.85 / $104,712.85
| Facility | | $104,712.85 | $104,712.85 | $104,712.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112,201.85 / $165,958.69 / $165,958.69
| Professional | | $112,201.85 | $165,958.69 | $165,958.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $21,877.62 / $33,113.11
| Facility | | $6,456.54 | $21,877.62 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $12,022.64 / $22,387.21
| Professional | | $9,772.37 | $12,022.64 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $11,220.18 / $11,220.18
| Professional | | $9,772.37 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $18,620.87 / $30,902.95
| Facility | | $9,772.37 | $18,620.87 | $30,902.95 |
- 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
- $7,585.78 / $15,135.61 / $22,908.68
| Facility | | $7,585.78 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,589.25 / $15,135.61
| Professional | | $8,317.64 | $12,589.25 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $22,908.68
| Professional | | $22,908.68 | $22,908.68 | $22,908.68 |