- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,293.03 / $5,293.03 / $5,716.47
| Facility | | $5,293.03 | $5,293.03 | $5,716.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,820.97 / $5,627.31 / $10,586.05
| Professional | | $4,820.97 | $5,627.31 | $10,586.05 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $12,089.57 / $12,089.57 / $12,089.57
| Facility | | $12,089.57 | $12,089.57 | $12,089.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,553.03 / $6,553.03 / $6,553.03
| Facility | | $6,553.03 | $6,553.03 | $6,553.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,783.71 / $4,783.71 / $6,553.03
| Professional | | $4,783.71 | $4,783.71 | $6,553.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,134.36 / $46,975.22 / $46,975.22
| Facility | | $18,134.36 | $46,975.22 | $46,975.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59,843.37 / $59,843.37 / $90,671.78
| Professional | | $59,843.37 | $59,843.37 | $90,671.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.30 / $8,425.26 / $12,089.57
| Facility | | $2,920.30 | $8,425.26 | $12,089.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,953.26 / $10,223.54 / $12,089.57
| Professional | | $2,953.26 | $10,223.54 | $12,089.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,920.30 / $8,077.91 / $12,089.57
| Facility | | $2,920.30 | $8,077.91 | $12,089.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,783.71 / $4,783.71 / $6,749.62
| Professional | | $4,783.71 | $4,783.71 | $6,749.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,769.60 / $5,576.48 / $6,922.19
| Professional | | $3,769.60 | $5,576.48 | $6,922.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,486.62 / $5,539.38 / $12,089.57
| Professional | | $5,486.62 | $5,539.38 | $12,089.57 |