- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,451.87 / $29,865.60 / $81,493.11
| Facility | | $10,451.87 | $29,865.60 | $81,493.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,000.78 / $11,066.71 / $13,592.42
| Professional | | $9,000.78 | $11,066.71 | $13,592.42 |
- 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
- $17,821.50 / $23,404.63 / $23,404.63
| Professional | | $17,821.50 | $23,404.63 | $23,404.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,034.23 / $13,034.23 / $23,000.09
| Facility | | $13,034.23 | $13,034.23 | $23,000.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,079.10 / $11,079.10 / $20,139.68
| Professional | | $11,079.10 | $11,079.10 | $20,139.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,160.08 / $23,000.09 / $43,700.17
| Professional | | $21,160.08 | $23,000.09 | $43,700.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,782.62 / $38,782.62 / $82,564.81
| Facility | | $38,782.62 | $38,782.62 | $82,564.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,451.89 / $31,657.60 / $86,539.13
| Facility | | $10,451.89 | $31,657.60 | $86,539.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,000.78 / $11,066.71 / $15,389.21
| Professional | | $9,000.78 | $11,066.71 | $15,389.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,578.90 / $31,369.00 / $45,314.30
| Professional | | $15,578.90 | $31,369.00 | $45,314.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,034.23 / $13,034.23 / $23,000.09
| Facility | | $13,034.23 | $13,034.23 | $23,000.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,079.10 / $11,079.10 / $27,402.38
| Professional | | $11,079.10 | $11,079.10 | $27,402.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,184.61 / $16,184.61 / $22,276.88
| Facility | | $16,184.61 | $16,184.61 | $22,276.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,184.61 / $22,276.88 / $22,498.13
| Professional | | $16,184.61 | $22,276.88 | $22,498.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,553.23 / $13,810.20 / $20,449.11
| Professional | | $10,553.23 | $13,810.20 | $20,449.11 |