- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,495.41 / $10,471.29
| Facility | | $812.83 | $5,495.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $363.08 / $812.83
| Professional | | $169.82 | $363.08 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $17,378.01 / $26,915.35
| Facility | | $8,912.51 | $17,378.01 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $645.65
| Professional | | $263.03 | $436.52 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $13,182.57
| Facility | | $851.14 | $851.14 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $630.96 / $977.24
| Professional | | $309.03 | $630.96 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $891.25
| Professional | | $407.38 | $630.96 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $234.42 / $234.42
| Professional | | $120.23 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,511.38 / $16,595.87
| Facility | | $5,370.32 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $467.74 / $977.24
| Professional | | $204.17 | $467.74 | $977.24 |