- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $933.25 / $1,862.09
| Professional | | $371.54 | $933.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,981.07 / $8,317.64
| Facility | | $1,621.81 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,288.25 / $1,548.82
| Professional | | $602.56 | $1,288.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $676.08 / $1,659.59
| Professional | | $457.09 | $676.08 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,230.27 / $3,311.31
| Facility | | $436.52 | $1,230.27 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,148.15 / $1,819.70
| Professional | | $512.86 | $1,148.15 | $1,819.70 |
- 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
- $5,754.40 / $7,244.36 / $10,471.29
| Facility | | $5,754.40 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $707.95 / $1,778.28
| Professional | | $630.96 | $707.95 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $794.33 / $6,918.31
| Professional | | $630.96 | $794.33 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $17,782.79 / $19,054.61
| Facility | | $9,332.54 | $17,782.79 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $891.25 / $1,819.70
| Professional | | $371.54 | $891.25 | $1,819.70 |