- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,466.84 / $5,495.41
| Facility | | $3,388.44 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,023.29 / $1,202.26
| Professional | | $676.08 | $1,023.29 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,630.78 / $9,332.54
| Facility | | $1,288.25 | $3,630.78 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,479.11 / $1,584.89
| Professional | | $1,202.26 | $1,479.11 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,380.38
| Professional | | $776.25 | $1,047.13 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,122.02 / $1,737.80
| Facility | | $676.08 | $1,122.02 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,318.26 / $1,479.11
| Professional | | $1,071.52 | $1,318.26 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,128.31 / $11,220.18
| Facility | | $6,456.54 | $8,128.31 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,479.11 / $1,659.59
| Professional | | $1,230.27 | $1,479.11 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $707.95 / $8,511.38
| Professional | | $676.08 | $707.95 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $16,982.44 / $18,197.01
| Facility | | $9,332.54 | $16,982.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,047.13 / $1,445.44
| Professional | | $794.33 | $1,047.13 | $1,445.44 |