- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,772.37 / $12,022.64
| Facility | | $7,244.36 | $9,772.37 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,623.41 / $12,589.25
| Professional | | $4,466.84 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $8,317.64 / $12,589.25
| Professional | | $1,412.54 | $8,317.64 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,120.11 / $11,220.18
| Professional | | $6,760.83 | $9,120.11 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,606.93 / $11,748.98
| Facility | | $4,265.80 | $6,606.93 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $9,120.11 / $12,022.64
| Professional | | $7,244.36 | $9,120.11 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,332.54 / $10,232.93
| Facility | | $7,413.10 | $9,332.54 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,606.93 / $11,220.18
| Facility | | $3,715.35 | $6,606.93 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $9,549.93 / $13,182.57
| Professional | | $79.43 | $9,549.93 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,302.68 / $26,302.68 / $26,302.68
| Facility | | $26,302.68 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,120.11 / $10,471.29 / $13,182.57
| Professional | | $9,120.11 | $10,471.29 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $7,585.78 / $31,622.78
| Facility | | $1,412.54 | $7,585.78 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $9,772.37 / $14,125.38
| Professional | | $5,248.07 | $9,772.37 | $14,125.38 |