- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,470.41 / $8,470.41 / $8,470.41
| Facility | | $8,470.41 | $8,470.41 | $8,470.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,677.89 / $7,084.01 / $8,470.41
| Professional | | $3,677.89 | $7,084.01 | $8,470.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,662.92 / $10,112.75 / $14,081.71
| Facility | | $8,662.92 | $10,112.75 | $14,081.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,090.20 / $9,607.11 / $10,112.75
| Professional | | $8,090.20 | $9,607.11 | $10,112.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,541.83 / $31,202.03 / $86,660.99
| Facility | | $6,541.83 | $31,202.03 | $86,660.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,723.63 / $12,427.04 / $14,889.00
| Professional | | $11,723.63 | $12,427.04 | $14,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,524.27 / $29,936.82 / $68,237.00
| Facility | | $18,524.27 | $29,936.82 | $68,237.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,723.63 / $11,723.63 / $12,064.00
| Professional | | $11,723.63 | $11,723.63 | $12,064.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,657.24 / $10,112.75 / $42,519.53
| Facility | | $2,657.24 | $10,112.75 | $42,519.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,664.10 / $4,470.82 / $10,155.03
| Professional | | $2,664.10 | $4,470.82 | $10,155.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,078.09 / $10,680.11 / $12,816.13
| Facility | | $9,078.09 | $10,680.11 | $12,816.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,664.10 / $4,834.55 / $13,348.83
| Professional | | $2,664.10 | $4,834.55 | $13,348.83 |