- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,194.11 / $8,194.11 / $8,194.11
| Facility | | $8,194.11 | $8,194.11 | $8,194.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,194.11 / $8,194.11 / $13,455.69
| Professional | | $8,194.11 | $8,194.11 | $13,455.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,966.50 / $31,434.34 / $87,176.00
| Facility | | $9,966.50 | $31,434.34 | $87,176.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,486.39 / $13,459.36 / $18,314.41
| Professional | | $8,486.39 | $13,459.36 | $18,314.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,905.38 / $24,217.19 / $31,187.16
| Facility | | $19,905.38 | $24,217.19 | $31,187.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,280.26 / $16,639.99 / $16,639.99
| Professional | | $12,280.26 | $16,639.99 | $16,639.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,847.64 / $11,736.82 / $13,147.53
| Facility | | $10,847.64 | $11,736.82 | $13,147.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,567.87 / $11,736.82 / $21,033.75
| Professional | | $8,567.87 | $11,736.82 | $21,033.75 |
- 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
- $15,184.25 / $15,184.25 / $15,943.46
| Professional | | $15,184.25 | $15,184.25 | $15,943.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,003.00 / $11,003.00 / $11,003.00
| Professional | | $11,003.00 | $11,003.00 | $11,003.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36,831.31 / $87,176.00 / $87,176.00
| Facility | | $36,831.31 | $87,176.00 | $87,176.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,325.77 / $10,024.70 / $18,314.41
| Professional | | $7,325.77 | $10,024.70 | $18,314.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,486.39 / $13,077.26 / $16,670.33
| Professional | | $8,486.39 | $13,077.26 | $16,670.33 |