- 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
- $154.88 / $213.80 / $245.47
| Professional | | $154.88 | $213.80 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $14,791.08
| Facility | | $1,122.02 | $1,122.02 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $257.04 / $467.74
| Facility | | $199.53 | $257.04 | $467.74 |
- 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
- $5,128.61 / $5,888.44 / $7,762.47
| Facility | | $5,128.61 | $5,888.44 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $239.88 / $363.08
| Professional | | $181.97 | $239.88 | $363.08 |