- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $4,265.80 / $20,417.38
| Facility | | $190.55 | $4,265.80 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $380.19 / $891.25
| Professional | | $154.88 | $380.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $229.09
| Facility | | $190.55 | $190.55 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Professional | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $302.00 / $302.00
| Facility | | $34.67 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $707.95 / $4,073.80
| Professional | | $173.78 | $707.95 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,165.95 / $10,232.93
| Facility | | $3,630.78 | $6,165.95 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $4,570.88
| Facility | | $1,230.27 | $1,230.27 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $537.03 / $1,584.89
| Professional | | $162.18 | $537.03 | $1,584.89 |