- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,244.36 / $7,943.28
| Facility | | $5,623.41 | $7,244.36 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $5,495.41
| Professional | | $234.42 | $363.08 | $5,495.41 |
- 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
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- 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
- $501.19 / $7,244.36 / $20,417.38
| Facility | | $501.19 | $7,244.36 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $891.25 / $20,417.38
| Professional | | $79.43 | $891.25 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,187.76 / $2,187.76
| Facility | | $331.13 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,659.59 / $1,659,586.91
| Facility | | $501.19 | $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
- $2,137.96 / $2,884.03 / $3,467.37
| Facility | | $2,137.96 | $2,884.03 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,047.13 / $1,122.02
| Professional | | $478.63 | $1,047.13 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,818.38 / $4,897.79
| Facility | | $1,096.48 | $2,818.38 | $4,897.79 |