- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.95 / $1,316.95 / $3,206.45
| Facility | | $1,316.95 | $1,316.95 | $3,206.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.58 / $1,422.30 / $2,633.89
| Professional | | $1,211.58 | $1,422.30 | $2,633.89 |
- 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
- $1,431.52 / $1,791.05 / $1,791.05
| Professional | | $1,431.52 | $1,791.05 | $1,791.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,007.98 / $3,007.98 / $3,007.98
| Facility | | $3,007.98 | $3,007.98 | $3,007.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.17 / $1,787.17 / $1,787.17
| Facility | | $1,787.17 | $1,787.17 | $1,787.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.63 / $1,304.63 / $1,304.63
| Professional | | $1,304.63 | $1,304.63 | $1,304.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,048.73 / $15,512.98 / $15,512.98
| Facility | | $13,048.73 | $15,512.98 | $15,512.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,680.88 / $15,680.88 / $24,501.38
| Professional | | $15,680.88 | $15,680.88 | $24,501.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.12 / $2,096.28 / $3,007.98
| Facility | | $789.12 | $2,096.28 | $3,007.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.03 / $2,719.64 / $3,007.98
| Professional | | $798.03 | $2,719.64 | $3,007.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.12 / $2,009.86 / $3,007.98
| Facility | | $789.12 | $2,009.86 | $3,007.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,304.63 / $1,304.63 / $2,380.34
| Professional | | $1,304.63 | $1,304.63 | $2,380.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.21 / $1,448.21 / $1,448.21
| Facility | | $1,448.21 | $1,448.21 | $1,448.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.62 / $1,506.88 / $1,841.70
| Professional | | $1,018.62 | $1,506.88 | $1,841.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.60 / $1,484.70 / $3,007.98
| Professional | | $1,482.60 | $1,484.70 | $3,007.98 |