- 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
- $251.19 / $407.38 / $977.24
| Professional | | $251.19 | $407.38 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $2,398.83 / $8,317.64
| Facility | | $446.68 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $645.65 / $851.14
| Professional | | $489.78 | $645.65 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $741.31
| Professional | | $288.40 | $446.68 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $501.19 / $1,000.00
| Facility | | $302.00 | $501.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $489.78 / $851.14
| Professional | | $302.00 | $489.78 | $851.14 |
- 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
- $416.87 / $588.84 / $870.96
| Professional | | $416.87 | $588.84 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $5,128.61
| Professional | | $295.12 | $467.74 | $5,128.61 |
- 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
- $288.40 / $436.52 / $741.31
| Professional | | $288.40 | $436.52 | $741.31 |