- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $8,709.64 / $10,471.29
| Facility | | $234.42 | $8,709.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $218.78 / $346.74
| Professional | | $46.77 | $218.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $83.18 / $562.34
| Professional | | $67.61 | $83.18 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $234.42 / $489.78
| Facility | | $60.26 | $234.42 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $21,379.62 / $28,840.32
| Facility | | $8,912.51 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $75.86 / $275.42
| Professional | | $48.98 | $75.86 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $24,547.09
| Facility | | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,235.94 / $3,235.94
| Professional | | $2,691.53 | $3,235.94 | $3,235.94 |