- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.61 / $3,066.61 / $3,311.93
| Facility | | $3,066.61 | $3,066.61 | $3,311.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,927.98 / $3,311.93 / $6,133.21
| Professional | | $2,927.98 | $3,311.93 | $6,133.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,004.30 / $7,004.30 / $7,004.30
| Facility | | $7,004.30 | $7,004.30 | $7,004.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,728.96 / $4,728.96 / $4,728.96
| Facility | | $4,728.96 | $4,728.96 | $4,728.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,452.14 / $3,452.14 / $4,728.96
| Professional | | $3,452.14 | $3,452.14 | $4,728.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,483.03 / $34,402.54 / $38,704.47
| Facility | | $16,483.03 | $34,402.54 | $38,704.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52,107.80 / $53,358.39 / $53,358.39
| Professional | | $52,107.80 | $53,358.39 | $53,358.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,968.27 / $4,881.31 / $7,004.30
| Facility | | $1,968.27 | $4,881.31 | $7,004.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,990.48 / $6,303.87 / $8,148.31
| Professional | | $1,990.48 | $6,303.87 | $8,148.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,968.27 / $4,728.96 / $7,004.30
| Facility | | $1,968.27 | $4,728.96 | $7,004.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,452.14 / $3,452.14 / $4,870.83
| Professional | | $3,452.14 | $3,452.14 | $4,870.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,926.06 / $6,926.06 / $8,148.31
| Facility | | $6,926.06 | $6,926.06 | $8,148.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,540.69 / $3,758.52 / $4,665.53
| Professional | | $2,540.69 | $3,758.52 | $4,665.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,670.43 / $3,697.96 / $7,004.30
| Professional | | $3,670.43 | $3,697.96 | $7,004.30 |