- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $7,244.36 / $7,244.36
| Facility | | $3,162.28 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,187.76 / $3,162.28
| Professional | | $1,862.09 | $2,187.76 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $208.93 / $8,912.51
| Professional | | $177.83 | $208.93 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,511.38 / $13,489.63
| Facility | | $7,244.36 | $8,511.38 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,244.36 / $8,317.64
| Professional | | $3,019.95 | $7,244.36 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $10,964.78 / $16,595.87
| Facility | | $2,691.53 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,848.93 / $15,848.93 / $17,782.79
| Professional | | $15,848.93 | $15,848.93 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,162.28 / $9,332.54
| Facility | | $2,187.76 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $13,182.57
| Professional | | $1,202.26 | $1,584.89 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $2,630.27
| Professional | | $50.12 | $70.79 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,165.95 / $8,709.64
| Professional | | $4,265.80 | $6,165.95 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $12,589.25 / $12,589.25
| Facility | | $5,248.07 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $13,182.57 / $13,182.57
| Professional | | $3,801.89 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Professional | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,454.40 / $14,454.40 / $14,454.40
| Professional | | $14,454.40 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $3,162.28
| Facility | | $2,137.96 | $2,137.96 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,584.89 / $4,365.16
| Professional | | $1,122.02 | $1,584.89 | $4,365.16 |