- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,493.50 / $5,493.50 / $5,932.98
| Facility | | $5,493.50 | $5,493.50 | $5,932.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,493.50 / $5,932.98 / $10,987.00
| Professional | | $5,493.50 | $5,932.98 | $10,987.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,471.16 / $7,471.16 / $7,471.16
| Professional | | $7,471.16 | $7,471.16 | $7,471.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,547.46 / $12,547.46 / $12,547.46
| Facility | | $12,547.46 | $12,547.46 | $12,547.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,121.18 / $8,121.18 / $8,121.18
| Facility | | $8,121.18 | $8,121.18 | $8,121.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,928.46 / $5,928.46 / $5,928.46
| Professional | | $5,928.46 | $5,928.46 | $5,928.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62,341.20 / $63,837.40 / $63,837.40
| Facility | | $62,341.20 | $63,837.40 | $63,837.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79,477.56 / $79,477.56 / $89,771.33
| Professional | | $79,477.56 | $79,477.56 | $89,771.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,855.07 / $8,744.37 / $12,547.46
| Facility | | $3,855.07 | $8,744.37 | $12,547.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,898.58 / $11,292.71 / $12,671.88
| Professional | | $3,898.58 | $11,292.71 | $12,671.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,855.07 / $8,383.86 / $12,547.46
| Facility | | $3,855.07 | $8,383.86 | $12,547.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,928.46 / $5,928.46 / $10,557.51
| Professional | | $5,928.46 | $5,928.46 | $10,557.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,976.22 / $7,361.47 / $8,997.16
| Professional | | $4,976.22 | $7,361.47 | $8,997.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,242.85 / $7,312.49 / $12,547.46
| Professional | | $7,242.85 | $7,312.49 | $12,547.46 |