- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $19,952.62
| Facility | | $4,570.88 | $9,332.54 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $186.21 / $8,709.64
| Professional | | $45.71 | $186.21 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $26,915.35 / $41,686.94
| Facility | | $16,982.44 | $26,915.35 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $56.23 / $251.19
| Professional | | $40.74 | $56.23 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $10,715.19 / $29,512.09
| Facility | | $5,128.61 | $10,715.19 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $95.50 / $457.09
| Professional | | $48.98 | $95.50 | $457.09 |