- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,715.19 / $13,803.84
| Facility | | $7,943.28 | $10,715.19 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,623.41 / $13,489.63
| Professional | | $4,466.84 | $5,623.41 | $13,489.63 |
- 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 / $8,511.38 / $12,589.25
| Professional | | $660.69 | $8,511.38 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,120.11 / $11,220.18
| Professional | | $6,606.93 | $9,120.11 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,760.83 / $11,748.98
| Facility | | $4,677.35 | $6,760.83 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,912.51 / $11,748.98
| Professional | | $7,244.36 | $8,912.51 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,332.54 / $9,772.37
| Facility | | $7,079.46 | $9,332.54 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,606.93 / $11,220.18
| Facility | | $4,365.16 | $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
- $25,703.96 / $25,703.96 / $25,703.96
| Facility | | $25,703.96 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,471.29 / $13,182.57
| Professional | | $8,912.51 | $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
- $5,495.41 / $9,549.93 / $13,803.84
| Professional | | $5,495.41 | $9,549.93 | $13,803.84 |