- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,466.84 / $15,848.93
| Facility | | $602.56 | $4,466.84 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $346.74 / $851.14
| Professional | | $151.36 | $346.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $251.19 / $346.74
| Professional | | $141.25 | $251.19 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $36,307.81 / $38,018.94
| Facility | | $5,128.61 | $36,307.81 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $8,912.51 / $8,912.51
| Facility | | $446.68 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $870.96
| Professional | | $371.54 | $501.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $630.96 / $47,863.01
| Facility | | $363.08 | $630.96 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $13,489.63
| Professional | | $363.08 | $512.86 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $14,454.40 / $34,673.69
| Facility | | $4,168.69 | $14,454.40 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $630.96
| Professional | | $363.08 | $467.74 | $630.96 |