- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $10,000.00 / $16,218.10
| Professional | | $8,511.38 | $10,000.00 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $32,359.37
| Facility | | $19,952.62 | $19,952.62 | $32,359.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,982.44 / $18,620.87 / $22,387.21
| Professional | | $16,982.44 | $18,620.87 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $45,708.82 / $97,723.72
| Facility | | $12,589.25 | $45,708.82 | $97,723.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $28,183.83 / $37,153.52
| Professional | | $9,120.11 | $28,183.83 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $15,848.93 / $24,547.09
| Facility | | $9,549.93 | $15,848.93 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $19,054.61 / $23,442.29
| Professional | | $11,220.18 | $19,054.61 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $19,498.45 / $91,201.08
| Facility | | $9,772.37 | $19,498.45 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,748.98 / $21,877.62
| Professional | | $8,709.64 | $11,748.98 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $70.79 / $13,182.57
| Professional | | $54.95 | $70.79 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,952.62 / $29,512.09 / $54,954.09
| Professional | | $19,952.62 | $29,512.09 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $39,810.72 / $91,201.08
| Facility | | $12,589.25 | $39,810.72 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $18,197.01 / $114,815.36
| Professional | | $9,120.11 | $18,197.01 | $114,815.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,182.57 / $28,840.32
| Facility | | $7,943.28 | $13,182.57 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,772.37 / $16,595.87
| Professional | | $7,244.36 | $9,772.37 | $16,595.87 |