- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,875.32 / $9,875.32 / $10,665.35
| Facility | | $9,875.32 | $9,875.32 | $10,665.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,875.32 / $10,665.35 / $19,750.64
| Professional | | $9,875.32 | $10,665.35 | $19,750.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,430.44 / $13,430.44 / $13,430.44
| Professional | | $13,430.44 | $13,430.44 | $13,430.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,555.79 / $22,555.79 / $22,555.79
| Facility | | $22,555.79 | $22,555.79 | $22,555.79 |
- 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 / $10,595.08 / $14,513.81
| Professional | | $10,595.08 | $10,595.08 | $14,513.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37,693.01 / $104,478.94 / $104,478.94
| Facility | | $37,693.01 | $104,478.94 | $104,478.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112,957.80 / $112,957.80 / $164,238.75
| Professional | | $112,957.80 | $112,957.80 | $164,238.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,455.32 / $16,933.86 / $22,555.79
| Facility | | $6,455.32 | $16,933.86 | $22,555.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,528.17 / $20,300.21 / $22,555.79
| Professional | | $6,528.17 | $20,300.21 | $22,555.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,455.32 / $15,071.15 / $22,555.79
| Facility | | $6,455.32 | $15,071.15 | $22,555.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,595.08 / $10,595.08 / $15,472.44
| Professional | | $10,595.08 | $10,595.08 | $15,472.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,332.68 / $12,326.78 / $15,171.22
| Professional | | $8,332.68 | $12,326.78 | $15,171.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,128.12 / $12,489.26 / $22,555.79
| Professional | | $12,128.12 | $12,489.26 | $22,555.79 |