- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Facility | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,217.75 / $16,608.54 / $16,608.54
| Professional | | $16,217.75 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,314.91 / $9,104.45 / $14,670.69
| Facility | | $4,314.91 | $9,104.45 | $14,670.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,631.57 / $15,631.57 / $19,220.57
| Professional | | $15,631.57 | $15,631.57 | $19,220.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,631.57 / $15,631.57 / $15,631.57
| Professional | | $15,631.57 | $15,631.57 | $15,631.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Facility | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,608.54 / $16,608.54 / $16,608.54
| Professional | | $16,608.54 | $16,608.54 | $16,608.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,353.63 / $5,121.92 / $18,562.49
| Professional | | $4,353.63 | $5,121.92 | $18,562.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,608.54 / $19,539.46 / $27,404.09
| Facility | | $16,608.54 | $19,539.46 | $27,404.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,570.70 / $6,709.00 / $8,702.33
| Professional | | $5,570.70 | $6,709.00 | $8,702.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,468.74 / $18,562.49 / $23,935.83
| Facility | | $15,468.74 | $18,562.49 | $23,935.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,468.74 / $18,562.49 / $23,935.83
| Professional | | $15,468.74 | $18,562.49 | $23,935.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,282.88 / $16,282.88 / $19,539.46
| Professional | | $16,282.88 | $16,282.88 | $19,539.46 |