- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,310.35 / $4,310.35 / $24,200.04
| Facility | | $4,310.35 | $4,310.35 | $24,200.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,310.35 / $4,409.47 / $7,630.00
| Professional | | $4,310.35 | $4,409.47 | $7,630.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,259.54 / $21,669.73 / $48,277.81
| Facility | | $7,259.54 | $21,669.73 | $48,277.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.89 / $7,259.54 / $9,633.95
| Professional | | $4,466.89 | $7,259.54 | $9,633.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,771.63 / $12,738.97 / $16,405.39
| Facility | | $10,771.63 | $12,738.97 | $16,405.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,265.45 / $7,265.45 / $8,224.75
| Professional | | $7,265.45 | $7,265.45 | $8,224.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,701.14 / $7,250.78 / $7,957.05
| Facility | | $5,701.14 | $7,250.78 | $7,957.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,763.49 / $7,957.05 / $11,763.75
| Professional | | $6,763.49 | $7,957.05 | $11,763.75 |
- 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
- $7,987.38 / $7,987.38 / $8,386.75
| Professional | | $7,987.38 | $7,987.38 | $8,386.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,031.33 / $12,031.33 / $12,031.33
| Facility | | $12,031.33 | $12,031.33 | $12,031.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,598.65 / $48,277.81 / $48,277.81
| Facility | | $20,598.65 | $48,277.81 | $48,277.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,853.58 / $5,273.30 / $9,633.95
| Professional | | $3,853.58 | $5,273.30 | $9,633.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,938.27 / $11,938.27 / $11,938.27
| Facility | | $11,938.27 | $11,938.27 | $11,938.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,284.55 / $5,273.30 / $9,633.95
| Professional | | $4,284.55 | $5,273.30 | $9,633.95 |