- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $7,079.46 / $17,378.01
| Facility | | $190.55 | $7,079.46 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $239.88 / $724.44
| Professional | | $165.96 | $239.88 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $239.88
| Facility | | $199.53 | $199.53 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Professional | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $1,659.59
| Facility | | $316.23 | $316.23 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $269.15 / $1,348.96
| Professional | | $177.83 | $269.15 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $12,022.64 / $13,182.57
| Facility | | $3,890.45 | $12,022.64 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $9,120.11
| Facility | | $2,454.71 | $2,454.71 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $346.74
| Professional | | $144.54 | $204.17 | $346.74 |