- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,594.80 / $10,594.81 / $10,594.81
| Facility | | $10,594.80 | $10,594.81 | $10,594.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,477.42 / $10,959.17 / $16,123.24
| Professional | | $9,477.42 | $10,959.17 | $16,123.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,256.59 / $43,274.03 / $184,182.63
| Facility | | $25,256.59 | $43,274.03 | $184,182.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,847.37 / $13,847.37 / $22,472.43
| Facility | | $13,847.37 | $13,847.37 | $22,472.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,108.58 / $13,847.37 / $24,816.00
| Professional | | $10,108.58 | $13,847.37 | $24,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,124.87 / $21,406.09 / $26,537.76
| Professional | | $17,124.87 | $21,406.09 | $26,537.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27,827.92 / $27,827.92 / $27,827.92
| Professional | | $27,827.92 | $27,827.92 | $27,827.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,149.86 / $10,679.26 / $18,332.73
| Professional | | $8,149.86 | $10,679.26 | $18,332.73 |