- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,440.91 / $18,286.09 / $21,850.60
| Facility | | $4,440.91 | $18,286.09 | $21,850.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,134.76 / $4,231.93 / $4,440.91
| Professional | | $3,134.76 | $4,231.93 | $4,440.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,075.19 / $4,075.19 / $4,075.19
| Professional | | $4,075.19 | $4,075.19 | $4,075.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,497.87 / $6,787.90 / $15,611.37
| Facility | | $3,497.87 | $6,787.90 | $15,611.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,182.57 / $25,182.57 / $25,182.57
| Professional | | $25,182.57 | $25,182.57 | $25,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,485.83 / $7,053.21 / $12,904.76
| Professional | | $5,485.83 | $7,053.21 | $12,904.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,817.59 / $18,028.00 / $21,850.60
| Facility | | $5,817.59 | $18,028.00 | $21,850.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,428.90 / $4,440.91 / $21,577.60
| Professional | | $3,428.90 | $4,440.91 | $21,577.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,732.41 / $7,836.90 / $10,449.20
| Professional | | $7,732.41 | $7,836.90 | $10,449.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,640.50 / $6,601.81 / $17,337.84
| Facility | | $3,640.50 | $6,601.81 | $17,337.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,182.57 / $25,182.57 / $25,182.57
| Professional | | $25,182.57 | $25,182.57 | $25,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,224.60 / $5,224.60 / $5,747.06
| Facility | | $5,224.60 | $5,224.60 | $5,747.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,224.60 / $5,224.60 / $5,747.06
| Professional | | $5,224.60 | $5,224.60 | $5,747.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,702.14 / $6,269.52 / $6,269.52
| Facility | | $4,702.14 | $6,269.52 | $6,269.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,194.33 / $3,134.76 / $9,561.02
| Professional | | $2,194.33 | $3,134.76 | $9,561.02 |