- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,466.84 / $5,495.41
| Facility | | $4,365.16 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,096.48
| Professional | | $575.44 | $776.25 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,570.88 / $8,912.51
| Facility | | $2,187.76 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,047.13 / $1,096.48
| Professional | | $891.25 | $1,047.13 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $851.14 / $1,047.13
| Professional | | $660.69 | $851.14 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $977.24 / $4,365.16
| Facility | | $549.54 | $977.24 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $954.99 / $1,122.02
| Professional | | $602.56 | $954.99 | $1,122.02 |
- 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
- $776.25 / $912.01 / $1,047.13
| Professional | | $776.25 | $912.01 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $933.25 / $8,317.64
| Professional | | $489.78 | $933.25 | $8,317.64 |
- 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
- $489.78 / $724.44 / $1,096.48
| Professional | | $489.78 | $724.44 | $1,096.48 |