- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,634.61 / $7,634.61 / $29,545.90
| Facility | | $7,634.61 | $7,634.61 | $29,545.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,690.27 / $8,083.71 / $10,778.28
| Professional | | $6,690.27 | $8,083.71 | $10,778.28 |
- 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
- $13,017.77 / $17,095.98 / $17,095.98
| Professional | | $13,017.77 | $17,095.98 | $17,095.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,812.54 / $9,812.54 / $17,095.98
| Facility | | $9,812.54 | $9,812.54 | $17,095.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,340.66 / $8,340.66 / $14,969.83
| Professional | | $8,340.66 | $8,340.66 | $14,969.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,728.30 / $17,095.98 / $32,482.36
| Professional | | $15,728.30 | $17,095.98 | $32,482.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,544.06 / $11,544.06 / $11,544.06
| Professional | | $11,544.06 | $11,544.06 | $11,544.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,634.61 / $7,634.61 / $29,545.90
| Facility | | $7,634.61 | $7,634.61 | $29,545.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,690.27 / $8,383.10 / $13,895.00
| Professional | | $6,690.27 | $8,383.10 | $13,895.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,694.20 / $33,682.10 / $33,682.10
| Professional | | $27,694.20 | $33,682.10 | $33,682.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,812.54 / $9,812.54 / $17,095.98
| Facility | | $9,812.54 | $9,812.54 | $17,095.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,340.66 / $8,340.66 / $20,306.25
| Professional | | $8,340.66 | $8,340.66 | $20,306.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,320.70 / $16,272.21 / $16,272.21
| Facility | | $12,320.70 | $16,272.21 | $16,272.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,320.70 / $16,272.21 / $16,671.82
| Professional | | $12,320.70 | $16,272.21 | $16,671.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,948.84 / $9,933.40 / $14,937.11
| Professional | | $7,948.84 | $9,933.40 | $14,937.11 |