- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,079.46 / $14,454.40
| Facility | | $3,715.35 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,230.27 / $2,570.40
| Professional | | $707.95 | $1,230.27 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $20,417.38
| Facility | | $7,943.28 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $1,698.24
| Professional | | $707.95 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,737.80 / $2,238.72
| Professional | | $831.76 | $1,737.80 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,230.27 / $10,471.29
| Facility | | $707.95 | $1,230.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,445.44 / $5,754.40
| Professional | | $794.33 | $1,445.44 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,737.80 / $2,398.83
| Professional | | $1,479.11 | $1,737.80 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,778.28 / $2,398.83
| Professional | | $1,698.24 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,549.93
| Facility | | $6,309.57 | $7,413.10 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $1,949.84
| Professional | | $794.33 | $1,348.96 | $1,949.84 |