- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,943.28 / $7,943.28
| Facility | | $2,691.53 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Professional | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $177.83
| Professional | | $169.82 | $169.82 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,691.53 / $20,417.38
| Facility | | $331.13 | $2,691.53 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,778.28 / $20,417.38
| Professional | | $79.43 | $1,778.28 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $588.84 / $588.84
| Facility | | $102.33 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,659.59 / $1,659,586.91
| Facility | | $331.13 | $1,659.59 | $1,659,586.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $79.43
| Professional | | $70.79 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $912.01
| Facility | | $549.54 | $758.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $263.03 / $281.84
| Professional | | $123.03 | $263.03 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,071.52 / $5,128.61
| Facility | | $186.21 | $1,071.52 | $5,128.61 |