- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $47,863.01
| Facility | | $4,265.80 | $4,265.80 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,011.87 / $8,709.64
| Professional | | $4,265.80 | $5,011.87 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,549.93 / $47,863.01
| Facility | | $9,332.54 | $9,549.93 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,244.36 / $11,481.54
| Professional | | $4,466.84 | $7,244.36 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $12,882.50 / $16,982.44
| Facility | | $10,964.78 | $12,882.50 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,317.64 / $8,317.64
| Professional | | $7,244.36 | $8,317.64 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,244.36 / $7,943.28
| Facility | | $5,754.40 | $7,244.36 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $7,943.28
| Professional | | $6,760.83 | $6,760.83 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $8,709.64 / $13,182.57
| Professional | | $8,709.64 | $8,709.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Facility | | $12,022.64 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,549.93 / $47,863.01
| Facility | | $9,332.54 | $9,549.93 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $7,413.10 / $13,803.84
| Professional | | $4,466.84 | $7,413.10 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $6,760.83 / $12,302.69
| Facility | | $7.08 | $6,760.83 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,760.83 / $8,709.64
| Professional | | $4,168.69 | $6,760.83 | $8,709.64 |