- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $870.96 / $3,019.95
| Professional | | $371.54 | $870.96 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $8,317.64
| Facility | | $1,698.24 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,318.26 / $1,737.80
| Professional | | $691.83 | $1,318.26 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $851.14 / $2,884.03
| Professional | | $436.52 | $851.14 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,096.48 / $3,019.95
| Facility | | $426.58 | $1,096.48 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $977.24 / $1,819.70
| Professional | | $537.03 | $977.24 | $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
- $5,248.07 / $7,244.36 / $10,232.93
| Facility | | $5,248.07 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,023.29 / $1,862.09
| Professional | | $616.60 | $1,023.29 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $851.14 / $5,495.41
| Professional | | $426.58 | $851.14 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,302.69 / $12,302.69
| Facility | | $5,495.41 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $912.01 / $4,466.84
| Professional | | $426.58 | $912.01 | $4,466.84 |