- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,228.90 / $20,532.00 / $22,612.60
| Facility | | $7,228.90 | $20,532.00 | $22,612.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,901.86 / $4,380.16 / $4,653.92
| Professional | | $2,901.86 | $4,380.16 | $4,653.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,270.66 / $4,270.66 / $4,270.66
| Professional | | $4,270.66 | $4,270.66 | $4,270.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,665.65 / $7,113.49 / $16,360.17
| Facility | | $3,665.65 | $7,113.49 | $16,360.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,390.46 / $26,390.46 / $26,390.46
| Professional | | $26,390.46 | $26,390.46 | $26,390.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,748.96 / $7,391.52 / $13,523.74
| Professional | | $5,748.96 | $7,391.52 | $13,523.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,426.33 / $22,612.60 / $22,612.60
| Facility | | $8,426.33 | $22,612.60 | $22,612.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,593.37 / $4,653.92 / $22,612.60
| Professional | | $3,593.37 | $4,653.92 | $22,612.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,103.30 / $8,212.79 / $10,950.40
| Professional | | $8,103.30 | $8,212.79 | $10,950.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,815.12 / $6,918.58 / $18,169.09
| Facility | | $3,815.12 | $6,918.58 | $18,169.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,390.46 / $26,390.46 / $26,390.46
| Professional | | $26,390.46 | $26,390.46 | $26,390.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,475.20 / $5,475.20 / $6,022.72
| Facility | | $5,475.20 | $5,475.20 | $6,022.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,475.20 / $5,475.20 / $6,022.72
| Professional | | $5,475.20 | $5,475.20 | $6,022.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,299.58 / $3,285.12 / $10,019.62
| Professional | | $2,299.58 | $3,285.12 | $10,019.62 |