- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,394.43 / $5,872.35 / $8,380.95
| Professional | | $4,394.43 | $5,872.35 | $8,380.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.79 / $603.79 / $603.79
| Professional | | $603.79 | $603.79 | $603.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,969.70 / $9,969.70 / $9,969.70
| Facility | | $9,969.70 | $9,969.70 | $9,969.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,933.43 / $4,933.43 / $9,791.93
| Facility | | $4,933.43 | $4,933.43 | $9,791.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,193.42 / $4,933.43 / $6,372.00
| Professional | | $4,193.42 | $4,933.43 | $6,372.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,806.08 / $54,554.97 / $56,543.95
| Facility | | $19,806.08 | $54,554.97 | $56,543.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,343.83 / $7,335.98 / $9,969.70
| Facility | | $3,343.83 | $7,335.98 | $9,969.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.21 / $1,052.74 / $9,559.82
| Professional | | $917.21 | $1,052.74 | $9,559.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,343.83 / $6,074.99 / $9,969.70
| Facility | | $3,343.83 | $6,074.99 | $9,969.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.57 / $4,933.43 / $5,081.43
| Professional | | $783.57 | $4,933.43 | $5,081.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.91 / $3,803.62 / $6,668.40
| Facility | | $470.91 | $3,803.62 | $6,668.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,901.14 / $5,088.18 / $7,430.74
| Professional | | $3,901.14 | $5,088.18 | $7,430.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,718.20 / $7,750.19 / $7,750.19
| Professional | | $6,718.20 | $7,750.19 | $7,750.19 |