- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $7,943.28 / $16,595.87
| Facility | | $177.83 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $147.91 / $316.23
| Professional | | $125.89 | $147.91 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $436.52
| Professional | | $114.82 | $165.96 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $204.17 / $331.13
| Professional | | $151.36 | $204.17 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $213.80 / $501.19
| Facility | | $147.91 | $213.80 | $501.19 |
- 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
- $2,454.71 / $6,760.83 / $9,120.11
| Facility | | $2,454.71 | $6,760.83 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $186.21 / $371.54
| Professional | | $128.82 | $186.21 | $371.54 |