- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,477.42 / $9,477.42 / $36,677.60
| Facility | | $9,477.42 | $9,477.42 | $36,677.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,505.99 / $10,034.91 / $11,674.91
| Professional | | $7,505.99 | $10,034.91 | $11,674.91 |
- 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
- $16,159.93 / $21,222.51 / $21,222.51
| Professional | | $16,159.93 | $21,222.51 | $21,222.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,847.37 / $13,847.37 / $19,180.41
| Facility | | $13,847.37 | $13,847.37 | $19,180.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $10,108.58 / $16,795.04
| Professional | | $10,108.58 | $10,108.58 | $16,795.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,645.98 / $19,180.41 / $36,442.78
| Professional | | $17,645.98 | $19,180.41 | $36,442.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,477.42 / $9,477.42 / $36,677.60
| Facility | | $9,477.42 | $9,477.42 | $36,677.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,505.99 / $10,034.91 / $13,806.01
| Professional | | $7,505.99 | $10,034.91 | $13,806.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,991.60 / $26,159.50 / $37,788.80
| Professional | | $12,991.60 | $26,159.50 | $37,788.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,847.37 / $13,847.37 / $19,180.41
| Facility | | $13,847.37 | $13,847.37 | $19,180.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $10,108.58 / $24,816.00
| Professional | | $10,108.58 | $10,108.58 | $24,816.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,141.21 / $10,141.21 / $20,199.91
| Facility | | $10,141.21 | $10,141.21 | $20,199.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,141.21 / $20,199.91 / $20,374.64
| Professional | | $10,141.21 | $20,199.91 | $20,374.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,568.90 / $11,469.98 / $19,138.63
| Professional | | $9,568.90 | $11,469.98 | $19,138.63 |