- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,176.51 / $3,176.51 / $3,430.63
| Facility | | $3,176.51 | $3,176.51 | $3,430.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,995.83 / $3,430.63 / $6,353.02
| Professional | | $2,995.83 | $3,430.63 | $6,353.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,320.05 / $4,320.05 / $4,320.05
| Professional | | $4,320.05 | $4,320.05 | $4,320.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,255.33 / $7,255.33 / $7,255.33
| Facility | | $7,255.33 | $7,255.33 | $7,255.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,790.37 / $3,790.37 / $3,790.37
| Facility | | $3,790.37 | $3,790.37 | $3,790.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,766.97 / $2,766.97 / $3,790.37
| Professional | | $2,766.97 | $2,766.97 | $3,790.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,480.40 / $32,412.74 / $38,417.86
| Facility | | $16,480.40 | $32,412.74 | $38,417.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,633.18 / $52,872.39 / $52,872.39
| Professional | | $51,633.18 | $52,872.39 | $52,872.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,953.69 / $5,056.26 / $7,255.33
| Facility | | $1,953.69 | $5,056.26 | $7,255.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.74 / $6,529.80 / $7,692.81
| Professional | | $1,975.74 | $6,529.80 | $7,692.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,953.69 / $4,847.80 / $7,255.33
| Facility | | $1,953.69 | $4,847.80 | $7,255.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,766.97 / $2,766.97 / $3,904.08
| Professional | | $2,766.97 | $2,766.97 | $3,904.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,521.88 / $3,730.69 / $4,591.55
| Professional | | $2,521.88 | $3,730.69 | $4,591.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,670.57 / $3,688.79 / $7,255.33
| Professional | | $3,670.57 | $3,688.79 | $7,255.33 |