- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $2,344.23 / $4,897.79
| Facility | | $138.04 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $147.91 / $309.03
| Professional | | $128.82 | $147.91 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $25,703.96 / $35,481.34
| Facility | | $10,232.93 | $25,703.96 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $346.74 / $524.81
| Professional | | $144.54 | $346.74 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $134.90 / $141.25
| Facility | | $120.23 | $134.90 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $269.15 / $524.81
| Facility | | $131.83 | $269.15 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $213.80 / $512.86
| Professional | | $131.83 | $213.80 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,754.40 / $12,022.64
| Facility | | $1,412.54 | $5,754.40 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.83 / $295.12
| Professional | | $120.23 | $177.83 | $295.12 |