- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,727.67 / $4,433.64 / $21,060.00
| Facility | | $2,727.67 | $4,433.64 | $21,060.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,433.64 / $4,788.33 / $8,867.27
| Professional | | $4,433.64 | $4,788.33 | $8,867.27 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $4,819.35 / $4,819.35 / $4,819.35
| Professional | | $4,819.35 | $4,819.35 | $4,819.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,126.67 / $10,126.67 / $10,126.67
| Facility | | $10,126.67 | $10,126.67 | $10,126.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,687.89 / $5,687.89 / $5,687.89
| Facility | | $5,687.89 | $5,687.89 | $5,687.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,834.71 / $4,834.71 / $5,687.89
| Professional | | $4,834.71 | $4,834.71 | $5,687.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,998.64 / $44,565.35 / $49,036.48
| Facility | | $20,998.64 | $44,565.35 | $49,036.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51,366.71 / $51,366.71 / $73,736.70
| Professional | | $51,366.71 | $51,366.71 | $73,736.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,119.78 / $8,867.27 / $10,126.67
| Facility | | $5,119.78 | $8,867.27 | $10,126.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,197.52 / $9,316.54 / $10,213.17
| Professional | | $6,197.52 | $9,316.54 | $10,213.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,310.32 / $6,667.01 / $10,126.67
| Facility | | $5,310.32 | $6,667.01 | $10,126.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,834.71 / $4,834.71 / $7,574.69
| Professional | | $4,834.71 | $4,834.71 | $7,574.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,784.36 / $5,699.53 / $7,124.41
| Professional | | $3,784.36 | $5,699.53 | $7,124.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,857.64 / $5,473.79 / $10,126.67
| Professional | | $4,857.64 | $5,473.79 | $10,126.67 |