- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,089.30 / $4,897.79
| Facility | | $758.58 | $2,089.30 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $630.96
| Professional | | $371.54 | $457.09 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,542.29 / $52,480.75 / $112,201.85
| Facility | | $27,542.29 | $52,480.75 | $112,201.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $676.08
| Professional | | $436.52 | $537.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $512.86 / $676.08
| Professional | | $338.84 | $512.86 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $20,892.96 / $52,480.75
| Facility | | $1,995.26 | $20,892.96 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $812.83
| Professional | | $363.08 | $512.86 | $812.83 |