- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,066.13 / $4,066.13 / $4,391.42
| Facility | | $4,066.13 | $4,066.13 | $4,391.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,066.13 / $4,529.42 / $8,132.26
| Professional | | $4,066.13 | $4,529.42 | $8,132.26 |
- 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
- $4,419.89 / $5,529.94 / $5,529.94
| Professional | | $4,419.89 | $5,529.94 | $5,529.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,287.27 / $9,287.27 / $9,287.27
| Facility | | $9,287.27 | $9,287.27 | $9,287.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,261.93 / $7,261.93 / $7,261.93
| Facility | | $7,261.93 | $7,261.93 | $7,261.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,301.21 / $5,301.21 / $5,301.21
| Professional | | $5,301.21 | $5,301.21 | $5,301.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48,028.87 / $48,511.09 / $48,511.09
| Facility | | $48,028.87 | $48,511.09 | $48,511.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52,297.82 / $52,297.82 / $69,356.55
| Professional | | $52,297.82 | $52,297.82 | $69,356.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,978.39 / $6,515.78 / $9,287.27
| Facility | | $2,978.39 | $6,515.78 | $9,287.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,012.00 / $8,430.50 / $10,214.07
| Professional | | $3,012.00 | $8,430.50 | $10,214.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,978.39 / $6,647.09 / $9,287.27
| Facility | | $2,978.39 | $6,647.09 | $9,287.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,301.21 / $5,301.21 / $8,492.81
| Professional | | $5,301.21 | $5,301.21 | $8,492.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,844.58 / $5,687.40 / $6,951.12
| Professional | | $3,844.58 | $5,687.40 | $6,951.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,595.76 / $5,623.53 / $9,287.27
| Professional | | $5,595.76 | $5,623.53 | $9,287.27 |