- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $18,197.01
| Facility | | $3,388.44 | $5,495.41 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Professional | | $18,197.01 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $36,307.81 / $54,954.09
| Facility | | $19,952.62 | $36,307.81 | $54,954.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,512.09 / $29,512.09 / $29,512.09
| Professional | | $29,512.09 | $29,512.09 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,495.41 / $21,379.62
| Facility | | $3,388.44 | $5,495.41 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,709.64 / $18,197.01
| Professional | | $4,466.84 | $8,709.64 | $18,197.01 |
- 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
- $31,622.78 / $41,686.94 / $60,255.96
| Facility | | $31,622.78 | $41,686.94 | $60,255.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,512.09 / $41,686.94 / $46,773.51
| Professional | | $29,512.09 | $41,686.94 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $25,118.86 / $66,069.34
| Facility | | $12,022.64 | $25,118.86 | $66,069.34 |