- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,665.46 / $5,665.46 / $5,665.46
| Facility | | $5,665.46 | $5,665.46 | $5,665.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,665.46 / $5,756.15 / $9,561.86
| Professional | | $5,665.46 | $5,756.15 | $9,561.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,915.60 / $21,811.80 / $65,339.36
| Facility | | $6,915.60 | $21,811.80 | $65,339.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,111.95 / $9,418.33 / $12,662.72
| Professional | | $6,111.95 | $9,418.33 | $12,662.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,762.72 / $16,743.93 / $21,563.02
| Facility | | $13,762.72 | $16,743.93 | $21,563.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,490.65 / $11,505.00 / $11,505.00
| Professional | | $8,490.65 | $11,505.00 | $11,505.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,500.14 / $9,077.06 / $9,090.28
| Facility | | $7,500.14 | $9,077.06 | $9,090.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,626.25 / $9,077.06 / $16,267.13
| Professional | | $6,626.25 | $9,077.06 | $16,267.13 |
- 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
- $10,498.49 / $10,498.49 / $11,023.41
| Professional | | $10,498.49 | $10,498.49 | $11,023.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,174.90 / $8,174.90 / $8,174.90
| Professional | | $8,174.90 | $8,174.90 | $8,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,484.68 / $65,339.36 / $65,339.36
| Facility | | $28,484.68 | $65,339.36 | $65,339.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,093.30 / $6,931.14 / $12,662.72
| Professional | | $5,093.30 | $6,931.14 | $12,662.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,359.46 / $6,931.14 / $12,516.70
| Professional | | $5,359.46 | $6,931.14 | $12,516.70 |