- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $9,120.11 / $16,595.87
| Facility | | $234.42 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $426.58 / $724.44
| Professional | | $234.42 | $426.58 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $11,481.54
| Facility | | $2,398.83 | $6,918.31 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $4,073.80
| Facility | | $3,235.94 | $3,235.94 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $407.38 / $912.01
| Facility | | $239.88 | $407.38 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $54.95
| Professional | | $30.20 | $30.20 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $17,378.01 / $25,703.96
| Facility | | $6,309.57 | $17,378.01 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $691.83 / $1,148.15
| Professional | | $338.84 | $691.83 | $1,148.15 |