- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,244.36 / $13,803.84
| Professional | | $6,165.95 | $7,244.36 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $14,791.08 / $75,857.76
| Facility | | $12,882.50 | $14,791.08 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,964.78 / $14,791.08
| Professional | | $6,760.83 | $10,964.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,488.17 / $19,054.61 / $25,118.86
| Facility | | $15,488.17 | $19,054.61 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,302.69 / $12,302.69
| Professional | | $9,549.93 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $9,332.54 / $10,232.93
| Facility | | $8,317.64 | $9,332.54 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $9,332.54
| Professional | | $6,918.31 | $6,918.31 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $19,498.45
| Professional | | $12,589.25 | $12,589.25 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $9,120.11
| Professional | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $14,791.08 / $75,857.76
| Facility | | $12,882.50 | $14,791.08 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $11,220.18 / $16,218.10
| Professional | | $6,760.83 | $11,220.18 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $10,715.19 / $19,498.45
| Facility | | $11.48 | $10,715.19 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,232.93 / $12,589.25
| Professional | | $6,309.57 | $10,232.93 | $12,589.25 |