- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,628.84 / $11,709.30 / $17,035.09
| Facility | | $8,628.84 | $11,709.30 | $17,035.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,121.26 / $8,628.84 / $8,628.84
| Professional | | $8,121.26 | $8,628.84 | $8,628.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.20 / $1,176.22 / $34,663.19
| Facility | | $375.20 | $1,176.22 | $34,663.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.00 / $8,459.66 / $38,576.00
| Professional | | $140.00 | $8,459.66 | $38,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,338.37 / $11,842.83 / $21,747.22
| Facility | | $10,338.37 | $11,842.83 | $21,747.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,304.94 / $8,628.84 / $8,628.84
| Facility | | $8,304.94 | $8,628.84 | $8,628.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,628.84 / $8,628.84 / $8,628.84
| Professional | | $8,628.84 | $8,628.84 | $8,628.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.29 / $366.29 / $430.93
| Professional | | $366.29 | $366.29 | $430.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,628.84 / $8,628.84 / $9,987.02
| Professional | | $8,628.84 | $8,628.84 | $9,987.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,644.00 / $34,663.19 / $34,663.19
| Facility | | $9,644.00 | $34,663.19 | $34,663.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,459.66 / $8,967.24 / $38,576.00
| Professional | | $8,459.66 | $8,967.24 | $38,576.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,459.66 / $8,628.84 / $11,240.35
| Professional | | $8,459.66 | $8,628.84 | $11,240.35 |