- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,981.07 / $7,079.46
| Facility | | $537.03 | $3,981.07 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $213.80 / $436.52
| Professional | | $107.15 | $213.80 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,168.69 / $12,022.64
| Facility | | $3,715.35 | $4,168.69 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $162.18 / $245.47
| Professional | | $117.49 | $162.18 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $239.88 / $426.58
| Professional | | $147.91 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $199.53 / $199.53
| Professional | | $194.98 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,332.54
| Facility | | $3,388.44 | $6,025.60 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $165.96 / $295.12
| Professional | | $112.20 | $165.96 | $295.12 |