- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,568.04 / $9,568.04 / $9,568.04
| Facility | | $9,568.04 | $9,568.04 | $9,568.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,568.04 / $10,091.35 / $17,425.27
| Professional | | $9,568.04 | $10,091.35 | $17,425.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,592.72 / $58,484.27 / $104,478.94
| Facility | | $19,592.72 | $58,484.27 | $104,478.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,999.21 / $16,267.40 / $21,385.25
| Professional | | $9,999.21 | $16,267.40 | $21,385.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,910.66 / $28,277.74 / $36,416.37
| Facility | | $23,910.66 | $28,277.74 | $36,416.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,359.73 / $19,430.05 / $19,430.05
| Professional | | $15,359.73 | $19,430.05 | $19,430.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,513.81 / $14,513.81 / $14,513.81
| Facility | | $14,513.81 | $14,513.81 | $14,513.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $14,513.81 / $26,010.38
| Professional | | $10,595.08 | $14,513.81 | $26,010.38 |
- 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
- $17,730.22 / $17,730.22 / $18,616.73
| Professional | | $17,730.22 | $17,730.22 | $18,616.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,986.72 / $15,986.72 / $15,986.72
| Professional | | $15,986.72 | $15,986.72 | $15,986.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,545.73 / $104,478.94 / $104,478.94
| Facility | | $45,545.73 | $104,478.94 | $104,478.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,554.10 / $11,705.58 / $21,385.25
| Professional | | $8,554.10 | $11,705.58 | $21,385.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,510.78 / $11,705.58 / $21,385.25
| Professional | | $9,510.78 | $11,705.58 | $21,385.25 |