- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,212.11 / $9,212.11 / $35,650.90
| Facility | | $9,212.11 | $9,212.11 | $35,650.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,024.92 / $9,754.00 / $12,352.55
| Professional | | $8,024.92 | $9,754.00 | $12,352.55 |
- 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
- $15,707.56 / $20,628.43 / $20,628.43
| Professional | | $15,707.56 | $20,628.43 | $20,628.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,752.32 / $12,752.32 / $20,506.48
| Facility | | $12,752.32 | $12,752.32 | $20,506.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,309.19 / $9,309.19 / $17,956.18
| Professional | | $9,309.19 | $9,309.19 | $17,956.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,865.96 / $20,506.48 / $38,962.31
| Professional | | $18,865.96 | $20,506.48 | $38,962.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,929.36 / $13,929.36 / $13,929.36
| Professional | | $13,929.36 | $13,929.36 | $13,929.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,212.11 / $9,212.11 / $35,650.90
| Facility | | $9,212.11 | $9,212.11 | $35,650.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,024.92 / $9,754.00 / $16,766.00
| Professional | | $8,024.92 | $9,754.00 | $16,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,425.50 / $29,239.30 / $40,401.40
| Professional | | $25,425.50 | $29,239.30 | $40,401.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,752.32 / $12,752.32 / $20,506.48
| Facility | | $12,752.32 | $12,752.32 | $20,506.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,309.19 / $9,309.19 / $24,708.38
| Professional | | $9,309.19 | $9,309.19 | $24,708.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,748.48 / $19,634.45 / $19,634.45
| Facility | | $14,748.48 | $19,634.45 | $19,634.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,748.48 / $19,634.45 / $20,286.28
| Professional | | $14,748.48 | $19,634.45 | $20,286.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,388.91 / $11,491.95 / $17,152.16
| Professional | | $9,388.91 | $11,491.95 | $17,152.16 |