- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $10,715.19
| Facility | | $346.74 | $346.74 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $199.53 / $371.54
| Professional | | $47.86 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $23,442.29 / $58,884.37
| Facility | | $12,882.50 | $23,442.29 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Professional | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $7,585.78 / $21,379.62
| Facility | | $524.81 | $7,585.78 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $102.33 / $363.08
| Professional | | $64.57 | $102.33 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $11,220.18 / $22,908.68
| Facility | | $1,584.89 | $11,220.18 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $154.88 / $537.03
| Professional | | $69.18 | $154.88 | $537.03 |