- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,307.38 / $11,307.38 / $11,307.38
| Facility | | $11,307.38 | $11,307.38 | $11,307.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,093.85 / $10,350.01 / $11,307.38
| Professional | | $5,093.85 | $10,350.01 | $11,307.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,564.36 / $13,499.77 / $18,798.04
| Facility | | $11,564.36 | $13,499.77 | $18,798.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,799.82 / $12,824.78 / $13,499.77
| Professional | | $10,799.82 | $12,824.78 | $13,499.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,732.85 / $41,653.05 / $115,687.82
| Facility | | $8,732.85 | $41,653.05 | $115,687.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,650.25 / $16,589.27 / $19,875.82
| Professional | | $15,650.25 | $16,589.27 | $19,875.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,728.92 / $39,964.06 / $91,092.78
| Facility | | $24,728.92 | $39,964.06 | $91,092.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,650.25 / $15,650.25 / $16,104.80
| Professional | | $15,650.25 | $15,650.25 | $16,104.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,680.26 / $13,499.77 / $58,756.37
| Facility | | $3,680.26 | $13,499.77 | $58,756.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,689.76 / $6,192.06 / $13,556.20
| Professional | | $3,689.76 | $6,192.06 | $13,556.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.86 / $5,544.86 / $5,544.86
| Facility | | $5,544.86 | $5,544.86 | $5,544.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,689.76 / $5,612.41 / $13,556.20
| Professional | | $3,689.76 | $5,612.41 | $13,556.20 |