- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,466.84 / $5,495.41
| Facility | | $3,388.44 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $870.96 / $2,041.74
| Professional | | $707.95 | $870.96 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $14,791.08
| Facility | | $2,398.83 | $6,918.31 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $1,548.82
| Professional | | $1,288.25 | $1,513.56 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,174.90 / $1,621.81
| Professional | | $676.08 | $1,174.90 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,174.90 / $2,290.87
| Facility | | $758.58 | $1,174.90 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,380.38 / $1,621.81
| Professional | | $851.14 | $1,380.38 | $1,621.81 |
- 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
- $9,772.37 / $12,882.50 / $18,197.01
| Facility | | $9,772.37 | $12,882.50 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $1,698.24
| Professional | | $1,174.90 | $1,548.82 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $758.58 / $9,332.54
| Professional | | $691.83 | $758.58 | $9,332.54 |
- 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
- $776.25 / $1,096.48 / $1,621.81
| Professional | | $776.25 | $1,096.48 | $1,621.81 |