- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $831.76 / $1,905.46
| Professional | | $204.17 | $831.76 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,265.80 / $8,912.51
| Facility | | $2,238.72 | $4,265.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,412.54 / $1,862.09
| Professional | | $363.08 | $1,412.54 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $676.08 / $2,137.96
| Professional | | $245.47 | $676.08 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $912.01 / $2,951.21
| Facility | | $223.87 | $912.01 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $870.96 / $1,905.46
| Professional | | $245.47 | $870.96 | $1,905.46 |
- 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
- $6,165.95 / $7,762.47 / $12,302.69
| Facility | | $6,165.95 | $7,762.47 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $2,398.83
| Professional | | $316.23 | $524.81 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $870.96 / $6,025.60
| Professional | | $223.87 | $870.96 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $16,982.44 / $18,197.01
| Facility | | $9,332.54 | $16,982.44 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $831.76 / $2,454.71
| Professional | | $245.47 | $831.76 | $2,454.71 |