- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $17,782.79 / $20,892.96
| Facility | | $6,309.57 | $17,782.79 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $6,309.57 / $7,244.36
| Professional | | $5,495.41 | $6,309.57 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $44,668.36 / $52,480.75
| Facility | | $33,884.42 | $44,668.36 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $363.08
| Professional | | $208.93 | $208.93 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,918.31 / $7,585.78
| Professional | | $6,456.54 | $6,918.31 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,595.87 / $43,651.58
| Facility | | $8,709.64 | $16,595.87 | $43,651.58 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,332.54 / $11,748.98
| Professional | | $8,511.38 | $9,332.54 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,128.31 / $13,182.57
| Facility | | $6,309.57 | $8,128.31 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $17,782.79
| Professional | | $5,495.41 | $5,495.41 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,549.93 / $17,378.01
| Facility | | $5,888.44 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,549.93 / $17,378.01
| Professional | | $5,888.44 | $9,549.93 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,511.38 / $10,232.93
| Facility | | $2,187.76 | $8,511.38 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,819.70 / $4,265.80
| Professional | | $1,548.82 | $1,819.70 | $4,265.80 |