- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $6,025.60 / $16,595.87
| Facility | | $398.11 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $151.36 / $371.54
| Professional | | $123.03 | $151.36 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $331.13 / $575.44
| Facility | | $177.83 | $331.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $223.87 / $316.23
| Professional | | $147.91 | $223.87 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $501.19
| Facility | | $346.74 | $346.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $234.42 / $346.74
| Professional | | $154.88 | $234.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $457.09
| Professional | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $190.55 / $416.87
| Facility | | $151.36 | $190.55 | $416.87 |
- 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
- $380.19 / $1,230.27 / $3,548.13
| Facility | | $380.19 | $1,230.27 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $354.81
| Professional | | $120.23 | $151.36 | $354.81 |