- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,630.78 / $6,025.60
| Facility | | $1,096.48 | $3,630.78 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,737.80 / $6,025.60
| Professional | | $398.11 | $1,737.80 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,370.32 / $15,488.17
| Facility | | $56.23 | $5,370.32 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,348.96 / $5,128.61
| Professional | | $407.38 | $1,348.96 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $1,023.29
| Facility | | $436.52 | $436.52 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,995.26 / $5,248.07
| Professional | | $602.56 | $1,995.26 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $724.44 / $7,079.46
| Facility | | $346.74 | $724.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,398.83 / $4,570.88
| Professional | | $1,995.26 | $2,398.83 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,659.59 / $4,265.80
| Professional | | $416.87 | $1,659.59 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $19,054.61
| Facility | | $562.34 | $562.34 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Professional | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $5,888.44 / $15,488.17
| Facility | | $56.23 | $5,888.44 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,348.96 / $5,128.61
| Professional | | $407.38 | $1,348.96 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $20,892.96
| Facility | | $2,570.40 | $7,244.36 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,949.84 / $5,248.07
| Professional | | $512.86 | $1,949.84 | $5,248.07 |