- 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
- $223.87 / $309.03 / $537.03
| Professional | | $223.87 | $309.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,073.80 / $9,120.11
| Facility | | $1,819.70 | $4,073.80 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $478.63
| Professional | | $389.05 | $457.09 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $380.19 / $457.09
| Professional | | $288.40 | $380.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $478.63 / $3,388.44
| Facility | | $281.84 | $478.63 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $398.11 / $478.63
| Professional | | $239.88 | $398.11 | $478.63 |
- 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
- $6,025.60 / $7,762.47 / $11,220.18
| Facility | | $6,025.60 | $7,762.47 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $380.19 / $457.09
| Professional | | $323.59 | $380.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $416.87 / $8,317.64
| Professional | | $199.53 | $416.87 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $25,118.86 / $38,904.51
| Facility | | $5,495.41 | $25,118.86 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $489.78
| Professional | | $245.47 | $338.84 | $489.78 |