- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $6,760.83
| Facility | | $338.84 | $338.84 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $512.86
| Professional | | $234.42 | $346.74 | $512.86 |
- 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
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $7,585.78 / $21,379.62
| Facility | | $537.03 | $7,585.78 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $1,698.24
| Professional | | $478.63 | $794.33 | $1,698.24 |
- 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
- $380.19 / $691.83 / $1,621.81
| Professional | | $380.19 | $691.83 | $1,621.81 |