- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,466.84 / $5,495.41
| Facility | | $1,621.81 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $741.31
| Professional | | $426.58 | $616.60 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $7,244.36 / $10,232.93
| Facility | | $5,128.61 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $912.01 / $954.99
| Professional | | $776.25 | $912.01 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $812.83
| Professional | | $512.86 | $660.69 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,071.52 / $5,495.41
| Facility | | $524.81 | $1,071.52 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $741.31 / $851.14
| Professional | | $478.63 | $741.31 | $851.14 |
- 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
- $5,888.44 / $7,413.10 / $10,232.93
| Facility | | $5,888.44 | $7,413.10 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $794.33
| Professional | | $562.34 | $776.25 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $407.38 / $8,317.64
| Professional | | $389.05 | $407.38 | $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
- $467.74 / $602.56 / $870.96
| Professional | | $467.74 | $602.56 | $870.96 |