- 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
- $190.55 / $251.19 / $302.00
| Professional | | $190.55 | $251.19 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,128.61 / $12,022.64
| Facility | | $2,691.53 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $363.08 / $371.54
| Professional | | $309.03 | $363.08 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $275.42 / $416.87
| Facility | | $204.17 | $275.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $269.15 / $4,168.69
| Professional | | $194.98 | $269.15 | $4,168.69 |
- 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
- $323.59 / $416.87 / $512.86
| Professional | | $323.59 | $416.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,238.72 / $8,912.51 / $12,022.64
| Professional | | $2,238.72 | $8,912.51 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $10,232.93 / $27,542.29
| Facility | | $2,089.30 | $10,232.93 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $630.96
| Professional | | $295.12 | $426.58 | $630.96 |