- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $575.44 / $7,943.28
| Facility | | $295.12 | $575.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $380.19
| Professional | | $371.54 | $371.54 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $46,773.51 / $46,773.51
| Facility | | $48.98 | $46,773.51 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $63.10 / $173.78
| Professional | | $48.98 | $63.10 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $18,197.01 / $35,481.34
| Facility | | $7,585.78 | $18,197.01 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $190.55 / $1,778.28
| Professional | | $64.57 | $190.55 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $10,964.78 / $27,542.29
| Facility | | $5,754.40 | $10,964.78 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $21,877.62 / $46,773.51
| Professional | | $5,248.07 | $21,877.62 | $46,773.51 |