- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,850.82 / $3,850.82 / $4,158.89
| Facility | | $3,850.82 | $3,850.82 | $4,158.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,850.82 / $4,158.89 / $7,701.64
| Professional | | $3,850.82 | $4,158.89 | $7,701.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,795.48 / $8,795.48 / $8,795.48
| Facility | | $8,795.48 | $8,795.48 | $8,795.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,541.83 / $6,541.83 / $6,541.83
| Facility | | $6,541.83 | $6,541.83 | $6,541.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,775.54 / $4,775.54 / $6,541.83
| Professional | | $4,775.54 | $4,775.54 | $6,541.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,989.41 / $42,519.53 / $42,519.53
| Facility | | $16,989.41 | $42,519.53 | $42,519.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48,489.51 / $48,489.51 / $60,075.68
| Professional | | $48,489.51 | $48,489.51 | $60,075.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,579.84 / $6,129.60 / $8,795.48
| Facility | | $2,579.84 | $6,129.60 | $8,795.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,608.96 / $7,915.93 / $9,339.51
| Professional | | $2,608.96 | $7,915.93 | $9,339.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,579.84 / $6,170.73 / $8,795.48
| Facility | | $2,579.84 | $6,170.73 | $8,795.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,775.54 / $4,775.54 / $6,738.08
| Professional | | $4,775.54 | $4,775.54 | $6,738.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,078.09 / $9,078.09 / $10,680.11
| Facility | | $9,078.09 | $9,078.09 | $10,680.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,330.12 / $5,015.42 / $6,020.97
| Professional | | $3,330.12 | $5,015.42 | $6,020.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,846.97 / $4,893.57 / $8,795.48
| Professional | | $4,846.97 | $4,893.57 | $8,795.48 |