- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $6,606.93 / $11,481.54
| Facility | | $2,344.23 | $6,606.93 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $380.19 / $6,760.83
| Professional | | $181.97 | $380.19 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,548.13 / $15,135.61
| Facility | | $1,698.24 | $3,548.13 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $97.72 / $660.69
| Professional | | $72.44 | $97.72 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $5,623.41 / $41,686.94
| Facility | | $371.54 | $5,623.41 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $6,309.57 / $11,220.18
| Professional | | $489.78 | $6,309.57 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $50.12 / $60.26
| Professional | | $39.81 | $50.12 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $4,570.88 / $4,570.88
| Facility | | $4,570.88 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $75.86
| Professional | | $60.26 | $60.26 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,754.40 / $8,912.51
| Facility | | $2,818.38 | $5,754.40 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $316.23 / $691.83
| Professional | | $229.09 | $316.23 | $691.83 |