- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $9,120.11 / $16,595.87
| Facility | | $186.21 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $190.55 / $223.87
| Professional | | $91.20 | $190.55 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $3,019.95
| Facility | | $977.24 | $1,698.24 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $194.98 / $245.47
| Professional | | $112.20 | $194.98 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $575.44 / $776.25
| Facility | | $354.81 | $575.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Professional | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $208.93 / $331.13
| Facility | | $123.03 | $208.93 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,890.45 / $7,762.47
| Facility | | $1,096.48 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $354.81
| Professional | | $162.18 | $208.93 | $354.81 |