- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $22,908.68
| Facility | | $3,388.44 | $5,495.41 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $22,908.68 / $22,908.68
| Professional | | $22,908.68 | $22,908.68 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $22,387.21 / $34,673.69
| Facility | | $9,549.93 | $22,387.21 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $18,620.87
| Professional | | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $26,915.35
| Facility | | $3,388.44 | $5,495.41 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,709.64 / $22,908.68
| Professional | | $4,466.84 | $8,709.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $24,547.09 / $37,153.52
| Facility | | $12,882.50 | $24,547.09 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $26,302.68 / $29,512.09
| Professional | | $18,620.87 | $26,302.68 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $26,915.35 / $29,512.09
| Facility | | $11,748.98 | $26,915.35 | $29,512.09 |