- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $22,908.68 / $34,673.69
| Facility | | $11,481.54 | $22,908.68 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,918.31 / $7,244.36
| Professional | | $4,570.88 | $6,918.31 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $6,606.93 / $6,606.93
| Professional | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $13,489.63 / $28,840.32
| Facility | | $8,317.64 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $40,738.03
| Professional | | $40,738.03 | $40,738.03 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $11,481.54 / $18,197.01
| Professional | | $8,912.51 | $11,481.54 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Facility | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,232.93 / $15,848.93
| Professional | | $6,309.57 | $10,232.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $21,379.62 / $34,673.69
| Facility | | $11,481.54 | $21,379.62 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,918.31 / $34,673.69
| Professional | | $5,128.61 | $6,918.31 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $9,332.54
| Facility | | $8,511.38 | $8,511.38 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $9,332.54
| Professional | | $8,511.38 | $8,511.38 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $10,232.93
| Facility | | $8,511.38 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $7,585.78
| Professional | | $1,548.82 | $2,187.76 | $7,585.78 |