- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,355.33 / $19,276.96
| Facility | | $4,083.97 | $8,355.33 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.69 / $441.12 / $801.67
| Professional | | $291.69 | $441.12 | $801.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.58 / $693.58 / $693.58
| Professional | | $693.58 | $693.58 | $693.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,489.78 / $7,958.64 / $13,966.90
| Facility | | $5,489.78 | $7,958.64 | $13,966.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.68 / $577.86 / $894.52
| Professional | | $307.68 | $577.86 | $894.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.73 / $977.62 / $1,379.98
| Professional | | $443.73 | $977.62 | $1,379.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.02 / $542.59 / $976.52
| Facility | | $301.02 | $542.59 | $976.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.00 / $1,096.69 / $3,530.88
| Professional | | $662.00 | $1,096.69 | $3,530.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.33 / $1,055.30 / $2,360.86
| Facility | | $710.33 | $1,055.30 | $2,360.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.97 / $885.05 / $1,236.49
| Professional | | $609.97 | $885.05 | $1,236.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.04 / $637.40 / $1,104.26
| Professional | | $333.04 | $637.40 | $1,104.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.13 / $1,032.05 / $1,217.99
| Professional | | $664.13 | $1,032.05 | $1,217.99 |