- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,890.37 / $10,890.37 / $13,213.29
| Facility | | $10,890.37 | $10,890.37 | $13,213.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,563.01 / $10,018.76 / $15,039.08
| Professional | | $5,563.01 | $10,018.76 | $15,039.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,777.82 / $11,155.72 / $11,155.72
| Facility | | $8,777.82 | $11,155.72 | $11,155.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,347.76 / $21,056.25 / $26,320.31
| Professional | | $1,347.76 | $21,056.25 | $26,320.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.63 / $1,728.63 / $14,994.41
| Professional | | $1,728.63 | $1,728.63 | $14,994.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,333.65 / $12,192.66 / $21,105.48
| Facility | | $2,333.65 | $12,192.66 | $21,105.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,747.08 / $6,040.36 / $16,542.54
| Professional | | $4,747.08 | $6,040.36 | $16,542.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,333.65 / $2,613.92 / $4,721.96
| Facility | | $2,333.65 | $2,613.92 | $4,721.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,151.42 / $2,496.36 / $4,721.96
| Professional | | $2,151.42 | $2,496.36 | $4,721.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,027.22 / $6,040.36 / $16,542.54
| Professional | | $5,027.22 | $6,040.36 | $16,542.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,912.76 / $16,345.26 / $16,345.26
| Professional | | $12,912.76 | $16,345.26 | $16,345.26 |