- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $9,549.93 / $22,908.68
| Facility | | $3,715.35 | $9,549.93 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,022.64 / $22,908.68
| Professional | | $4,365.16 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,715.19 / $17,782.79
| Facility | | $6,025.60 | $10,715.19 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $316.23 / $331.13
| Professional | | $295.12 | $316.23 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $27,542.29 / $33,884.42
| Facility | | $8,511.38 | $27,542.29 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $11,481.54
| Facility | | $9,772.37 | $9,772.37 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,748.98
| Professional | | $11,220.18 | $11,220.18 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Professional | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43,651.58 / $43,651.58 / $43,651.58
| Facility | | $43,651.58 | $43,651.58 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $22,908.68 / $33,884.42
| Facility | | $11,481.54 | $22,908.68 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $12.59 / $12.59
| Professional | | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |