- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,589.25 / $38,018.94
| Facility | | $5,495.41 | $12,589.25 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,309.57 / $9,332.54
| Professional | | $5,128.61 | $6,309.57 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $8,511.38
| Professional | | $8,511.38 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,585.78 / $8,709.64
| Professional | | $5,888.44 | $7,585.78 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,022.64 / $38,018.94
| Facility | | $5,495.41 | $12,022.64 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $12,302.69
| Professional | | $10,232.93 | $10,232.93 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39,810.72 / $39,810.72 / $39,810.72
| Facility | | $39,810.72 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41,686.94 / $63,095.73 / $63,095.73
| Professional | | $41,686.94 | $63,095.73 | $63,095.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,709.64 / $15,848.93
| Facility | | $6,456.54 | $8,709.64 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,585.78 / $10,471.29
| Professional | | $5,248.07 | $7,585.78 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $8,511.38 / $23,442.29
| Facility | | $5,888.44 | $8,511.38 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,332.54 / $14,791.08
| Professional | | $7,585.78 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,548.13 / $8,511.38
| Facility | | $3,019.95 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $3,548.13
| Professional | | $1,548.82 | $1,548.82 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $8,511.38 / $8,511.38
| Professional | | $1,445.44 | $8,511.38 | $8,511.38 |