- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,748.98 / $16,595.87
| Facility | | $5,370.32 | $11,748.98 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,317.64 / $13,489.63
| Professional | | $6,309.57 | $8,317.64 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $29,512.09
| Facility | | $14,791.08 | $14,791.08 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $25,118.86
| Professional | | $8,912.51 | $8,912.51 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $12,022.64 / $12,022.64
| Facility | | $11,220.18 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Professional | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $25,703.96 / $50,118.72
| Facility | | $10,000.00 | $25,703.96 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $14,454.40
| Professional | | $7,244.36 | $7,244.36 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $24,547.09 / $56,234.13
| Facility | | $14,791.08 | $24,547.09 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $16,218.10 / $28,183.83
| Professional | | $9,120.11 | $16,218.10 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $9,332.54 / $10,471.29
| Professional | | $8,709.64 | $9,332.54 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $14,125.38 / $14,125.38
| Professional | | $9,549.93 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $11,481.54 / $19,498.45
| Facility | | $6,025.60 | $11,481.54 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,762.47 / $12,022.64
| Professional | | $4,786.30 | $7,762.47 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,709.64 / $9,120.11
| Facility | | $8,317.64 | $8,709.64 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $9,332.54
| Professional | | $8,709.64 | $8,709.64 | $9,332.54 |