- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,244.36 / $16,595.87
| Facility | | $4,265.80 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $177.83 / $741.31
| Professional | | $134.90 | $177.83 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,128.31 / $15,848.93
| Facility | | $2,344.23 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $7,585.78
| Facility | | $5,888.44 | $5,888.44 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $223.87 / $741.31
| Facility | | $177.83 | $223.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $17,378.01 / $26,302.68
| Facility | | $6,309.57 | $17,378.01 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $407.38
| Professional | | $144.54 | $223.87 | $407.38 |