- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $7,943.28 / $16,595.87
| Facility | | $316.23 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $263.03 / $537.03
| Professional | | $223.87 | $263.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $295.12 / $707.95
| Professional | | $208.93 | $295.12 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $524.81
| Professional | | $223.87 | $331.13 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $331.13 / $549.54
| Facility | | $239.88 | $331.13 | $549.54 |
- 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
- $229.09 / $316.23 / $562.34
| Professional | | $229.09 | $316.23 | $562.34 |