- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,141.78 / $9,141.78 / $9,873.12
| Facility | | $9,141.78 | $9,141.78 | $9,873.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,141.78 / $9,873.12 / $18,283.56
| Professional | | $9,141.78 | $9,873.12 | $18,283.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,937.12 / $12,432.82 / $12,432.82
| Professional | | $9,937.12 | $12,432.82 | $12,432.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,880.34 / $20,880.34 / $20,880.34
| Facility | | $20,880.34 | $20,880.34 | $20,880.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,752.32 / $12,752.32 / $12,752.32
| Facility | | $12,752.32 | $12,752.32 | $12,752.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,309.19 / $9,309.19 / $12,752.32
| Professional | | $9,309.19 | $9,309.19 | $12,752.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,265.90 / $98,186.49 / $98,388.60
| Facility | | $43,265.90 | $98,186.49 | $98,388.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106,003.63 / $106,003.63 / $153,798.60
| Professional | | $106,003.63 | $106,003.63 | $153,798.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,364.39 / $16,482.29 / $20,880.34
| Facility | | $6,364.39 | $16,482.29 | $20,880.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,364.39 / $18,792.31 / $20,880.34
| Professional | | $6,364.39 | $18,792.31 | $20,880.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,364.39 / $15,676.01 / $20,880.34
| Facility | | $6,364.39 | $15,676.01 | $20,880.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,309.19 / $9,309.19 / $17,205.24
| Professional | | $9,309.19 | $9,309.19 | $17,205.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,824.10 / $11,574.43 / $14,245.24
| Professional | | $7,824.10 | $11,574.43 | $14,245.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,303.16 / $11,387.93 / $20,880.34
| Professional | | $11,303.16 | $11,387.93 | $20,880.34 |