- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,096.48 / $2,137.96
| Professional | | $371.54 | $1,096.48 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $10,964.78 / $25,703.96
| Facility | | $2,630.27 | $10,964.78 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $630.96 / $630.96
| Professional | | $501.19 | $630.96 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $19,498.45 / $46,773.51
| Facility | | $13,803.84 | $19,498.45 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,456.54 / $7,413.10
| Professional | | $5,888.44 | $6,456.54 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $18,620.87 / $36,307.81
| Facility | | $15,135.61 | $18,620.87 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $8,128.31
| Professional | | $5,888.44 | $5,888.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $8,128.31
| Facility | | $1,737.80 | $2,238.72 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,365.16 / $15,488.17
| Professional | | $1,412.54 | $4,365.16 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,311.31 / $14,791.08
| Professional | | $1,202.26 | $3,311.31 | $14,791.08 |