- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,709.58 / $7,709.58 / $8,326.34
| Facility | | $7,709.58 | $7,709.58 | $8,326.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,709.58 / $8,326.34 / $15,419.15
| Professional | | $7,709.58 | $8,326.34 | $15,419.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,485.02 / $10,485.02 / $10,485.02
| Professional | | $10,485.02 | $10,485.02 | $10,485.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,419.15 / $15,419.15 / $17,609.11
| Facility | | $15,419.15 | $15,419.15 | $17,609.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,812.54 / $9,812.54 / $9,812.54
| Facility | | $9,812.54 | $9,812.54 | $9,812.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,340.66 / $8,340.66 / $9,812.54
| Professional | | $8,340.66 | $8,340.66 | $9,812.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,426.58 / $81,836.25 / $81,836.25
| Facility | | $29,426.58 | $81,836.25 | $81,836.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89,678.01 / $89,678.01 / $128,219.85
| Professional | | $89,678.01 | $89,678.01 | $128,219.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,836.06 / $14,967.74 / $17,609.11
| Facility | | $8,836.06 | $14,967.74 | $17,609.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,501.68 / $16,200.38 / $18,116.77
| Professional | | $11,501.68 | $16,200.38 | $18,116.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,234.04 / $11,501.68 / $17,609.11
| Facility | | $9,234.04 | $11,501.68 | $17,609.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,340.66 / $8,340.66 / $14,214.99
| Professional | | $8,340.66 | $8,340.66 | $14,214.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,528.64 / $9,735.28 / $12,169.09
| Professional | | $6,528.64 | $9,735.28 | $12,169.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,672.80 / $9,476.36 / $17,609.11
| Professional | | $5,672.80 | $9,476.36 | $17,609.11 |