- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $6,025.60 / $16,595.87
| Facility | | $218.78 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $169.82 / $263.03
| Professional | | $107.15 | $169.82 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,737.80 / $3,467.37
| Facility | | $758.58 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $190.55 / $263.03
| Professional | | $112.20 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $269.15
| Professional | | $120.23 | $186.21 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $281.84
| Facility | | $120.23 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,890.45 / $7,762.47
| Facility | | $1,122.02 | $3,890.45 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $162.18 / $275.42
| Professional | | $104.71 | $162.18 | $275.42 |