- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,223.07 / $3,223.07 / $3,257.39
| Facility | | $3,223.07 | $3,223.07 | $3,257.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,223.07 / $3,223.07 / $3,670.43
| Professional | | $3,223.07 | $3,223.07 | $3,670.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,111.24 / $6,111.24 / $6,490.14
| Facility | | $6,111.24 | $6,111.24 | $6,490.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,670.43 / $3,670.43 / $4,887.17
| Professional | | $3,670.43 | $3,670.43 | $4,887.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,277.00 / $3,277.00 / $4,177.60
| Professional | | $3,277.00 | $3,277.00 | $4,177.60 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $4,277.87 / $5,500.12 / $7,333.49
| Professional | | $4,277.87 | $5,500.12 | $7,333.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,968.27 / $3,770.99 / $6,956.57
| Facility | | $1,968.27 | $3,770.99 | $6,956.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,459.00 / $8,027.14 / $10,179.35
| Professional | | $3,459.00 | $8,027.14 | $10,179.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,348.16 / $4,592.63 / $7,293.63
| Facility | | $3,348.16 | $4,592.63 | $7,293.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,348.16 / $4,592.63 / $7,293.63
| Professional | | $3,348.16 | $4,592.63 | $7,293.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.31 / $8,148.31 / $9,777.96
| Facility | | $8,148.31 | $8,148.31 | $9,777.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,860.58 / $3,048.83 / $4,698.14
| Professional | | $2,860.58 | $3,048.83 | $4,698.14 |