- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,382.21 / $6,382.21 / $6,892.78
| Facility | | $6,382.21 | $6,382.21 | $6,892.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,871.63 / $6,892.78 / $12,764.41
| Professional | | $5,871.63 | $6,892.78 | $12,764.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,577.32 / $14,577.32 / $14,577.32
| Facility | | $14,577.32 | $14,577.32 | $14,577.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,732.85 / $8,732.85 / $8,732.85
| Facility | | $8,732.85 | $8,732.85 | $8,732.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,374.98 / $6,374.98 / $8,732.85
| Professional | | $6,374.98 | $6,374.98 | $8,732.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,679.61 / $58,756.37 / $58,756.37
| Facility | | $22,679.61 | $58,756.37 | $58,756.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72,157.73 / $72,157.73 / $101,671.95
| Professional | | $72,157.73 | $72,157.73 | $101,671.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.07 / $10,158.99 / $14,577.32
| Facility | | $3,573.07 | $10,158.99 | $14,577.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,613.40 / $12,327.32 / $14,577.32
| Professional | | $3,613.40 | $12,327.32 | $14,577.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.07 / $9,740.16 / $14,577.32
| Facility | | $3,573.07 | $9,740.16 | $14,577.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,374.98 / $6,374.98 / $8,994.84
| Professional | | $6,374.98 | $6,374.98 | $8,994.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,544.86 / $5,544.86 / $5,544.86
| Facility | | $5,544.86 | $5,544.86 | $5,544.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,612.20 / $6,822.97 / $8,469.50
| Professional | | $4,612.20 | $6,822.97 | $8,469.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,713.03 / $6,777.58 / $14,577.32
| Professional | | $6,713.03 | $6,777.58 | $14,577.32 |