- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,121.26 / $8,324.29 / $17,541.90
| Facility | | $8,121.26 | $8,324.29 | $17,541.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,121.26 / $8,324.29 / $9,644.00
| Professional | | $8,121.26 | $8,324.29 | $9,644.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,620.31 / $17,049.90 / $34,018.97
| Facility | | $6,620.31 | $17,049.90 | $34,018.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- 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
- $9,644.00 / $34,663.19 / $36,639.44
| Facility | | $9,644.00 | $34,663.19 | $36,639.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37,127.98 / $38,576.00 / $43,967.34
| Professional | | $37,127.98 | $38,576.00 | $43,967.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.27 / $8,324.29 / $10,963.71
| Facility | | $301.27 | $8,324.29 | $10,963.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.58 / $524.75 / $7,613.69
| Professional | | $273.58 | $524.75 | $7,613.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $27.40 / $407.20
| Professional | | $27.40 | $27.40 | $407.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.98 / $8,324.29 / $10,574.58
| Facility | | $303.98 | $8,324.29 | $10,574.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,628.84 / $8,628.84 / $10,083.91
| Professional | | $8,628.84 | $8,628.84 | $10,083.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,459.66 / $8,967.24 / $9,417.37
| Professional | | $8,459.66 | $8,967.24 | $9,417.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,142.11 / $8,142.11 / $11,398.95
| Professional | | $8,142.11 | $8,142.11 | $11,398.95 |