- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $3,311.31 / $10,964.78
| Facility | | $177.83 | $3,311.31 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $316.23 / $616.60
| Professional | | $147.91 | $316.23 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $616.60
| Professional | | $131.83 | $173.78 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,317.64 / $10,471.29
| Facility | | $2,344.23 | $8,317.64 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $371.54 / $794.33
| Professional | | $177.83 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $151.36 / $173.78
| Facility | | $144.54 | $151.36 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $331.13 / $741.31
| Facility | | $169.82 | $331.13 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $323.59 / $660.69
| Professional | | $158.49 | $323.59 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,715.35 / $6,456.54
| Facility | | $1,698.24 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $281.84 / $512.86
| Professional | | $147.91 | $281.84 | $512.86 |