- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,771.02 / $8,771.02 / $8,771.02
| Facility | | $8,771.02 | $8,771.02 | $8,771.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,771.02 / $8,771.02 / $14,142.51
| Professional | | $8,771.02 | $8,771.02 | $14,142.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,678.50 / $33,679.99 / $90,961.51
| Facility | | $10,678.50 | $33,679.99 | $90,961.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,733.27 / $13,850.91 / $19,603.83
| Professional | | $8,733.27 | $13,850.91 | $19,603.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,306.80 / $25,922.18 / $33,382.87
| Facility | | $21,306.80 | $25,922.18 | $33,382.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,144.87 / $17,811.50 / $17,811.50
| Professional | | $13,144.87 | $17,811.50 | $17,811.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,611.39 / $12,562.99 / $14,073.20
| Facility | | $11,611.39 | $12,562.99 | $14,073.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,170.98 / $12,562.99 / $22,514.25
| Professional | | $9,170.98 | $12,562.99 | $22,514.25 |
- 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
- $16,253.28 / $16,253.28 / $17,065.93
| Professional | | $16,253.28 | $16,253.28 | $17,065.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,465.33 / $11,465.33 / $11,465.33
| Professional | | $11,465.33 | $11,465.33 | $11,465.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,423.83 / $90,961.51 / $90,961.51
| Facility | | $39,423.83 | $90,961.51 | $90,961.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,841.53 / $10,730.50 / $19,603.83
| Professional | | $7,841.53 | $10,730.50 | $19,603.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,718.53 / $11,287.56 / $17,505.43
| Professional | | $8,718.53 | $11,287.56 | $17,505.43 |