- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $6,309.57 / $10,471.29
| Facility | | $1,513.56 | $6,309.57 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $186.21 / $371.54
| Professional | | $46.77 | $186.21 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58,884.37 / $58,884.37 / $58,884.37
| Facility | | $58,884.37 | $58,884.37 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,370.32 / $10,471.29
| Facility | | $1,122.02 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $213.80 / $6,165.95
| Professional | | $46.77 | $213.80 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $8,128.31 / $25,703.96
| Facility | | $3,311.31 | $8,128.31 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $66.07 / $398.11
| Professional | | $47.86 | $66.07 | $398.11 |