- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,728.43 / $23,587.70 / $28,185.60
| Facility | | $5,728.43 | $23,587.70 | $28,185.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,043.60 / $5,458.86 / $5,728.43
| Professional | | $4,043.60 | $5,458.86 | $5,728.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,256.68 / $5,256.68 / $5,256.68
| Professional | | $5,256.68 | $5,256.68 | $5,256.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.97 / $8,761.12 / $22,364.48
| Facility | | $4,511.97 | $8,761.12 | $22,364.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32,483.57 / $32,483.57 / $32,483.57
| Professional | | $32,483.57 | $32,483.57 | $32,483.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,076.30 / $9,098.10 / $16,646.15
| Professional | | $7,076.30 | $9,098.10 | $16,646.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,504.24 / $23,254.70 / $28,185.60
| Facility | | $7,504.24 | $23,254.70 | $28,185.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,423.02 / $5,728.43 / $27,833.40
| Professional | | $4,423.02 | $5,728.43 | $27,833.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,974.20 / $10,109.00 / $13,478.66
| Professional | | $9,974.20 | $10,109.00 | $13,478.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,511.97 / $8,761.12 / $22,364.48
| Facility | | $4,511.97 | $8,761.12 | $22,364.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32,483.57 / $32,483.57 / $32,483.57
| Professional | | $32,483.57 | $32,483.57 | $32,483.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,739.33 / $6,739.33 / $6,739.33
| Facility | | $6,739.33 | $6,739.33 | $6,739.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,739.33 / $6,739.33 / $6,739.33
| Professional | | $6,739.33 | $6,739.33 | $6,739.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.52 / $2,830.52 / $2,830.52
| Facility | | $2,830.52 | $2,830.52 | $2,830.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,830.52 / $4,043.60 / $8,998.35
| Professional | | $2,830.52 | $4,043.60 | $8,998.35 |