- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,570.40 / $7,762.47
| Facility | | $1,148.15 | $2,570.40 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $371.54 / $1,862.09
| Professional | | $323.59 | $371.54 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $323.59 / $354.81
| Professional | | $162.18 | $323.59 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $9,332.54 / $10,964.78
| Facility | | $4,466.84 | $9,332.54 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $512.86 / $758.58
| Professional | | $389.05 | $512.86 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $16,982.44 / $17,782.79
| Facility | | $3,019.95 | $16,982.44 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $616.60
| Professional | | $309.03 | $426.58 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $4,786.30
| Professional | | $295.12 | $446.68 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $4,786.30
| Professional | | $489.78 | $489.78 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $354.81
| Professional | | $331.13 | $331.13 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,677.35 / $12,022.64
| Facility | | $2,951.21 | $4,677.35 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $426.58 / $645.65
| Professional | | $331.13 | $426.58 | $645.65 |