- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,011.87 / $12,589.25
| Facility | | $2,344.23 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $1,819.70
| Professional | | $309.03 | $426.58 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,709.64 / $16,982.44
| Facility | | $6,606.93 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $741.31
| Professional | | $316.23 | $524.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $776.25 / $954.99
| Professional | | $389.05 | $776.25 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $575.44 / $8,912.51
| Facility | | $309.03 | $575.44 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $707.95 / $4,677.35
| Professional | | $407.38 | $707.95 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $794.33 / $1,096.48
| Professional | | $660.69 | $794.33 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $776.25 / $1,096.48
| Professional | | $741.31 | $776.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $6,456.54 / $9,549.93
| Facility | | $3,715.35 | $6,456.54 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $645.65 / $912.01
| Professional | | $389.05 | $645.65 | $912.01 |