- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,571.93 / $12,571.93 / $48,653.40
| Facility | | $12,571.93 | $12,571.93 | $48,653.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,585.90 / $13,311.46 / $17,748.61
| Professional | | $11,585.90 | $13,311.46 | $17,748.61 |
- 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
- $21,436.38 / $28,151.96 / $28,151.96
| Professional | | $21,436.38 | $28,151.96 | $28,151.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,524.00 / $16,524.00 / $28,151.96
| Facility | | $16,524.00 | $16,524.00 | $28,151.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,062.52 / $12,062.52 / $24,650.85
| Professional | | $12,062.52 | $12,062.52 | $24,650.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,899.80 / $28,151.96 / $53,488.72
| Professional | | $25,899.80 | $28,151.96 | $53,488.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,009.63 / $19,009.63 / $19,009.63
| Professional | | $19,009.63 | $19,009.63 | $19,009.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,571.93 / $12,571.93 / $48,653.40
| Facility | | $12,571.93 | $12,571.93 | $48,653.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,054.27 / $13,804.48 / $19,396.25
| Professional | | $12,054.27 | $13,804.48 | $19,396.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.50 / $38,395.50 / $55,464.40
| Professional | | $546.50 | $38,395.50 | $55,464.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,524.00 / $16,524.00 / $28,151.96
| Facility | | $16,524.00 | $16,524.00 | $28,151.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,062.52 / $12,062.52 / $33,438.37
| Professional | | $12,062.52 | $12,062.52 | $33,438.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,127.49 / $26,795.47 / $26,795.47
| Facility | | $20,127.49 | $26,795.47 | $26,795.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,127.49 / $26,795.47 / $27,453.53
| Professional | | $20,127.49 | $26,795.47 | $27,453.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,888.14 / $16,891.18 / $25,970.95
| Professional | | $11,888.14 | $16,891.18 | $25,970.95 |