- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $15,848.93
| Facility | | $2,691.53 | $6,918.31 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,623.41 / $7,244.36
| Professional | | $2,691.53 | $5,623.41 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,199.52 / $39,810.72 / $46,773.51
| Facility | | $30,199.52 | $39,810.72 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,479.11
| Professional | | $851.14 | $851.14 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,165.95 / $6,918.31
| Professional | | $5,888.44 | $6,165.95 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,791.08 / $38,904.51
| Facility | | $7,762.47 | $14,791.08 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $10,964.78
| Professional | | $9,332.54 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,317.64 / $10,715.19
| Professional | | $7,585.78 | $8,317.64 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,606.93 / $10,715.19
| Facility | | $2,818.38 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $15,848.93
| Professional | | $4,897.79 | $4,897.79 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $8,709.64 / $15,848.93
| Facility | | $5,623.41 | $8,709.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $9,120.11 / $15,848.93
| Professional | | $5,370.32 | $9,120.11 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,585.78 / $9,120.11
| Facility | | $4,570.88 | $7,585.78 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $8,709.64
| Professional | | $3,162.28 | $3,801.89 | $8,709.64 |