- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,762.80 / $7,919.69 / $31,703.61
| Facility | | $3,762.80 | $7,919.69 | $31,703.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,762.80 / $4,337.32 / $6,198.38
| Professional | | $3,762.80 | $4,337.32 | $6,198.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,211.04 / $4,197.43 / $12,629.33
| Professional | | $3,211.04 | $4,197.43 | $12,629.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,617.73 / $8,191.11 / $8,191.11
| Facility | | $7,617.73 | $8,191.11 | $8,191.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,191.11 / $8,191.11 / $8,191.11
| Professional | | $8,191.11 | $8,191.11 | $8,191.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,687.89 / $5,687.89 / $5,687.89
| Facility | | $5,687.89 | $5,687.89 | $5,687.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,834.71 / $4,834.71 / $5,687.89
| Professional | | $4,834.71 | $4,834.71 | $5,687.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $9,831.56 / $22,121.01
| Facility | | $319.00 | $9,831.56 | $22,121.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,800.62 / $7,373.67 / $17,913.09
| Professional | | $5,800.62 | $7,373.67 | $17,913.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,463.71 / $6,867.69 / $8,191.11
| Professional | | $6,463.71 | $6,867.69 | $8,191.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $5,687.89 / $9,831.56
| Facility | | $597.00 | $5,687.89 | $9,831.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,834.71 / $5,687.89 / $14,649.02
| Professional | | $4,834.71 | $5,687.89 | $14,649.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,269.90 / $6,000.96 / $8,992.24
| Professional | | $3,269.90 | $6,000.96 | $8,992.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,463.71 / $6,463.71 / $6,463.71
| Facility | | $6,463.71 | $6,463.71 | $6,463.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,463.71 / $6,463.71 / $6,867.69
| Professional | | $6,463.71 | $6,463.71 | $6,867.69 |