- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $5,495.41 / $5,495.41
| Facility | | $4,466.84 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $173.78 / $251.19
| Professional | | $151.36 | $173.78 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,897.79 / $12,022.64
| Facility | | $2,454.71 | $4,897.79 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $346.74 / $363.08
| Professional | | $295.12 | $346.74 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $4,466.84
| Facility | | $151.36 | $186.21 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $173.78 / $251.19
| Professional | | $151.36 | $173.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,471.29 / $14,454.40
| Facility | | $7,762.47 | $10,471.29 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $245.47 / $269.15
| Professional | | $229.09 | $245.47 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,964.78 / $12,302.69
| Professional | | $7,585.78 | $10,964.78 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $22,387.21 / $27,542.29
| Facility | | $10,232.93 | $22,387.21 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $316.23
| Professional | | $162.18 | $213.80 | $316.23 |