- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $5,495.41 / $9,332.54
| Facility | | $371.54 | $5,495.41 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $389.05 / $5,011.87
| Professional | | $169.82 | $389.05 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,481.54 / $18,620.87
| Facility | | $3,715.35 | $11,481.54 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $3,981.07 / $5,011.87
| Professional | | $316.23 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $5,370.32
| Professional | | $208.93 | $363.08 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $4,073.80 / $9,332.54
| Facility | | $309.03 | $4,073.80 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $380.19 / $5,128.61
| Professional | | $177.83 | $380.19 | $5,128.61 |
- 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
- $10,471.29 / $13,182.57 / $18,620.87
| Facility | | $10,471.29 | $13,182.57 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $4,570.88
| Professional | | $234.42 | $288.40 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $2,344.23 / $13,803.84
| Professional | | $288.40 | $2,344.23 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $22,387.21 / $27,542.29
| Facility | | $10,232.93 | $22,387.21 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $2,754.23 / $5,888.44
| Professional | | $194.98 | $2,754.23 | $5,888.44 |