- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,317.64 / $10,471.29
| Facility | | $6,165.95 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,677.35 / $11,220.18
| Professional | | $3,715.35 | $4,677.35 | $11,220.18 |
- 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
- $660.69 / $7,244.36 / $10,715.19
| Professional | | $660.69 | $7,244.36 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,943.28 / $9,772.37
| Professional | | $5,754.40 | $7,943.28 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $5,623.41 / $9,549.93
| Facility | | $3,981.07 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,244.36 / $10,232.93
| Professional | | $5,754.40 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,762.47 / $8,511.38
| Facility | | $5,495.41 | $7,762.47 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,623.41 / $9,332.54
| Facility | | $3,801.89 | $5,623.41 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $8,128.31 / $11,481.54
| Professional | | $79.43 | $8,128.31 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $20,417.38 / $20,417.38
| Facility | | $20,417.38 | $20,417.38 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $8,912.51 / $11,481.54
| Professional | | $7,585.78 | $8,912.51 | $11,481.54 |
- 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
- $4,466.84 / $7,762.47 / $11,748.98
| Professional | | $4,466.84 | $7,762.47 | $11,748.98 |