- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $7,244.36 / $16,595.87
| Facility | | $977.24 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $407.38 / $562.34
| Professional | | $346.74 | $407.38 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $9,549.93
| Facility | | $2,137.96 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $363.08 / $549.54
| Professional | | $316.23 | $363.08 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,230.27 / $1,584.89
| Facility | | $501.19 | $1,230.27 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $812.83
| Professional | | $346.74 | $467.74 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $812.83
| Facility | | $346.74 | $489.78 | $812.83 |
- 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
- $2,754.23 / $10,964.78 / $16,982.44
| Facility | | $2,754.23 | $10,964.78 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $724.44
| Professional | | $323.59 | $407.38 | $724.44 |