- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,623.41
| Facility | | $5,128.61 | $5,128.61 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,754.40 / $10,232.93
| Professional | | $4,677.35 | $5,754.40 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $12,022.64 / $12,022.64
| Facility | | $79.43 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $8,128.31
| Professional | | $5,888.44 | $5,888.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,234.13 / $56,234.13 / $56,234.13
| Facility | | $56,234.13 | $56,234.13 | $56,234.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69,183.10 / $83,176.38 / $83,176.38
| Professional | | $69,183.10 | $83,176.38 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $9,772.37 / $14,791.08
| Facility | | $5,011.87 | $9,772.37 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,309.57 / $12,302.69
| Professional | | $4,786.30 | $6,309.57 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $9,120.11
| Professional | | $8,912.51 | $8,912.51 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $9,120.11 / $14,791.08
| Facility | | $5,011.87 | $9,120.11 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $8,128.31
| Professional | | $5,888.44 | $5,888.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $7,413.10 / $12,302.69
| Facility | | $3,981.07 | $7,413.10 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,456.54 / $8,128.31
| Professional | | $4,365.16 | $6,456.54 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,022.64 / $12,022.64 / $12,022.64
| Professional | | $12,022.64 | $12,022.64 | $12,022.64 |