- 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
- $457.09 / $524.81 / $2,818.38
| Professional | | $457.09 | $524.81 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $457.09
| Professional | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,715.19 / $20,892.96
| Facility | | $8,128.31 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $776.25 / $1,096.48
| Professional | | $467.74 | $776.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $1,071.52 / $1,479.11
| Professional | | $489.78 | $1,071.52 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $10,471.29
| Facility | | $457.09 | $812.83 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $851.14 / $3,715.35
| Professional | | $489.78 | $851.14 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,047.13 / $1,548.82
| Professional | | $977.24 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,148.15 / $1,548.82
| Professional | | $1,096.48 | $1,148.15 | $1,548.82 |
- 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
- $524.81 / $831.76 / $1,174.90
| Professional | | $524.81 | $831.76 | $1,174.90 |