- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,845.07 / $5,845.07 / $6,312.68
| Facility | | $5,845.07 | $5,845.07 | $6,312.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,845.07 / $6,312.68 / $11,690.14
| Professional | | $5,845.07 | $6,312.68 | $11,690.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,949.30 / $7,949.30 / $7,949.30
| Professional | | $7,949.30 | $7,949.30 | $7,949.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,350.47 / $13,350.47 / $13,350.47
| Facility | | $13,350.47 | $13,350.47 | $13,350.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,077.06 / $9,077.06 / $9,077.06
| Facility | | $9,077.06 | $9,077.06 | $9,077.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,626.25 / $6,626.25 / $9,077.06
| Professional | | $6,626.25 | $6,626.25 | $9,077.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63,807.96 / $65,339.36 / $65,339.36
| Facility | | $63,807.96 | $65,339.36 | $65,339.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81,347.50 / $81,347.50 / $93,875.25
| Professional | | $81,347.50 | $81,347.50 | $93,875.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,945.77 / $9,303.98 / $13,350.47
| Facility | | $3,945.77 | $9,303.98 | $13,350.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,990.30 / $12,015.42 / $13,442.59
| Professional | | $3,990.30 | $12,015.42 | $13,442.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,945.77 / $9,077.06 / $13,350.47
| Facility | | $3,945.77 | $9,077.06 | $13,350.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,626.25 / $6,626.25 / $9,349.37
| Professional | | $6,626.25 | $6,626.25 | $9,349.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,093.30 / $7,534.66 / $9,208.84
| Professional | | $5,093.30 | $7,534.66 | $9,208.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.26 / $7,450.05 / $13,350.47
| Professional | | $7,413.26 | $7,450.05 | $13,350.47 |