- 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
- $446.68 / $575.44 / $851.14
| Professional | | $446.68 | $575.44 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,786.30 / $16,982.44
| Facility | | $2,187.76 | $4,786.30 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $870.96
| Professional | | $724.44 | $851.14 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $831.76
| Professional | | $512.86 | $691.83 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $851.14 / $3,388.44
| Facility | | $457.09 | $851.14 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $870.96
| Professional | | $446.68 | $758.58 | $870.96 |
- 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
- $7,585.78 / $14,454.40 / $23,988.33
| Facility | | $7,585.78 | $14,454.40 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $691.83 / $831.76
| Professional | | $588.84 | $691.83 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $758.58 / $15,848.93
| Professional | | $371.54 | $758.58 | $15,848.93 |
- 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
- $426.58 / $602.56 / $891.25
| Professional | | $426.58 | $602.56 | $891.25 |