- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.84 / $2,060.84 / $2,225.71
| Facility | | $2,060.84 | $2,060.84 | $2,225.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,060.84 / $2,225.71 / $4,121.68
| Professional | | $2,060.84 | $2,225.71 | $4,121.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,240.14 / $2,802.74 / $2,802.74
| Professional | | $2,240.14 | $2,802.74 | $2,802.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,707.08 / $4,707.08 / $4,707.08
| Facility | | $4,707.08 | $4,707.08 | $4,707.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,780.72 / $2,780.72 / $2,780.72
| Facility | | $2,780.72 | $2,780.72 | $2,780.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.93 / $2,029.93 / $2,780.72
| Professional | | $2,029.93 | $2,029.93 | $2,780.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,421.34 / $24,060.65 / $24,060.65
| Facility | | $23,421.34 | $24,060.65 | $24,060.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29,548.98 / $29,548.98 / $43,828.28
| Professional | | $29,548.98 | $29,548.98 | $43,828.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.28 / $3,302.39 / $4,707.08
| Facility | | $1,433.28 | $3,302.39 | $4,707.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,449.45 / $4,236.37 / $4,865.79
| Professional | | $1,449.45 | $4,236.37 | $4,865.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.28 / $3,145.13 / $4,707.08
| Facility | | $1,433.28 | $3,145.13 | $4,707.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,029.93 / $2,029.93 / $2,964.38
| Professional | | $2,029.93 | $2,029.93 | $2,964.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.11 / $2,736.92 / $3,345.05
| Professional | | $1,850.11 | $2,736.92 | $3,345.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,692.82 / $2,704.43 / $4,707.08
| Professional | | $2,692.82 | $2,704.43 | $4,707.08 |