- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,079.46
| Facility | | $7,079.46 | $7,079.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,079.46 / $11,748.98
| Professional | | $5,623.41 | $7,079.46 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $23,442.29
| Facility | | $14,454.40 | $14,454.40 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $13,182.57 / $15,848.93
| Professional | | $12,022.64 | $13,182.57 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $33,113.11 / $70,794.58
| Facility | | $9,120.11 | $33,113.11 | $70,794.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $20,417.38 / $26,915.35
| Professional | | $6,606.93 | $20,417.38 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,481.54 / $17,782.79
| Facility | | $6,760.83 | $11,481.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,882.50 / $16,982.44
| Professional | | $7,943.28 | $12,882.50 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $14,125.38 / $63,095.73
| Facility | | $7,079.46 | $14,125.38 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,511.38 / $15,848.93
| Professional | | $6,165.95 | $8,511.38 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $70.79 / $9,549.93
| Professional | | $54.95 | $70.79 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,454.40 / $21,379.62 / $38,904.51
| Professional | | $14,454.40 | $21,379.62 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $28,183.83 / $66,069.34
| Facility | | $9,120.11 | $28,183.83 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $13,182.57 / $81,283.05
| Professional | | $6,606.93 | $13,182.57 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,120.11 / $19,952.62
| Facility | | $5,128.61 | $9,120.11 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,079.46 / $11,748.98
| Professional | | $5,128.61 | $7,079.46 | $11,748.98 |