- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,669.00 / $26,537.70 / $31,314.50
| Facility | | $11,669.00 | $26,537.70 | $31,314.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.54 / $2,666.54 / $2,666.54
| Professional | | $2,666.54 | $2,666.54 | $2,666.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,914.12 / $5,914.12 / $5,914.12
| Professional | | $5,914.12 | $5,914.12 | $5,914.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,195.51 / $10,389.21 / $25,161.40
| Facility | | $7,195.51 | $10,389.21 | $25,161.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,546.19 / $36,546.19 / $36,546.19
| Professional | | $36,546.19 | $36,546.19 | $36,546.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,961.31 / $10,235.96 / $18,728.03
| Professional | | $7,961.31 | $10,235.96 | $18,728.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,617.50 / $31,314.50 / $31,314.50
| Facility | | $20,617.50 | $31,314.50 | $31,314.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,666.54 / $31,314.50 / $31,314.50
| Professional | | $2,666.54 | $31,314.50 | $31,314.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,221.66 / $11,373.30 / $15,164.40
| Professional | | $11,221.66 | $11,373.30 | $15,164.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,380.27 / $11,736.78 / $25,161.40
| Facility | | $7,380.27 | $11,736.78 | $25,161.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,546.19 / $36,546.19 / $36,546.19
| Professional | | $36,546.19 | $36,546.19 | $36,546.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,582.20 / $7,582.20 / $8,340.42
| Facility | | $7,582.20 | $7,582.20 | $8,340.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,582.20 / $7,582.20 / $8,340.42
| Professional | | $7,582.20 | $7,582.20 | $8,340.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,184.52 / $4,549.32 / $11,373.30
| Professional | | $3,184.52 | $4,549.32 | $11,373.30 |