- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $2,818.38 / $8,511.38
| Facility | | $229.09 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $263.03 / $346.74
| Professional | | $234.42 | $263.03 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $10,715.19 / $11,220.18
| Facility | | $5,011.87 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $288.40 / $316.23
| Professional | | $234.42 | $288.40 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $288.40 / $346.74
| Facility | | $204.17 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $302.00 / $354.81
| Professional | | $213.80 | $302.00 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $389.05 / $389.05
| Facility | | $34.67 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $1,071.52
| Professional | | $275.42 | $436.52 | $1,071.52 |
- 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
- $602.56 / $4,466.84 / $30,199.52
| Facility | | $602.56 | $4,466.84 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $478.63
| Professional | | $234.42 | $363.08 | $478.63 |