- 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
- $407.38 / $478.63 / $812.83
| Professional | | $407.38 | $478.63 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $18,197.01 / $29,512.09
| Facility | | $10,471.29 | $18,197.01 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $371.54 / $436.52
| Professional | | $173.78 | $371.54 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,174.90 / $5,495.41
| Facility | | $512.86 | $1,174.90 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $478.63 / $812.83
| Professional | | $234.42 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $20,892.96 / $29,512.09
| Facility | | $11,748.98 | $20,892.96 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $758.58
| Professional | | $501.19 | $660.69 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $23,442.29
| Professional | | $436.52 | $436.52 | $23,442.29 |
- 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
- $416.87 / $537.03 / $776.25
| Professional | | $416.87 | $537.03 | $776.25 |