- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $6,760.83 / $8,709.64
| Facility | | $218.78 | $6,760.83 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $223.87 / $602.56
| Professional | | $186.21 | $223.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $776.25
| Professional | | $309.03 | $524.81 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $234.42 / $575.44
| Facility | | $181.97 | $234.42 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $9,549.93 / $14,454.40
| Facility | | $2,754.23 | $9,549.93 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $346.74 / $741.31
| Professional | | $229.09 | $346.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $4,677.35
| Professional | | $3,467.37 | $4,677.35 | $4,677.35 |