- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,466.84
| Facility | | $4,168.69 | $4,168.69 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,570.88 / $8,128.31
| Professional | | $3,467.37 | $4,570.88 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $9,549.93 / $9,549.93
| Facility | | $79.43 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $6,309.57 / $6,309.57
| Facility | | $6,309.57 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $6,309.57
| Professional | | $4,570.88 | $4,570.88 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41,686.94 / $41,686.94 / $41,686.94
| Facility | | $41,686.94 | $41,686.94 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,286.14 / $60,255.96 / $60,255.96
| Professional | | $51,286.14 | $60,255.96 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,762.47 / $11,748.98
| Facility | | $4,073.80 | $7,762.47 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,786.30 / $10,232.93
| Professional | | $3,715.35 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $7,079.46 / $7,244.36
| Professional | | $7,079.46 | $7,079.46 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,244.36 / $11,748.98
| Facility | | $4,073.80 | $7,244.36 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $6,309.57
| Professional | | $4,570.88 | $4,570.88 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,623.41 / $9,332.54
| Facility | | $3,019.95 | $5,623.41 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,011.87 / $6,165.95
| Professional | | $3,388.44 | $5,011.87 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Professional | | $9,549.93 | $9,549.93 | $9,549.93 |