- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,981.07 / $9,332.54
| Facility | | $741.31 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $181.97 / $346.74
| Professional | | $107.15 | $181.97 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,621.81 / $1,905.46
| Facility | | $204.17 | $1,621.81 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $218.78 / $416.87
| Professional | | $123.03 | $218.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $158.49 / $204.17
| Professional | | $147.91 | $158.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $251.19
| Professional | | $32.36 | $33.11 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,630.78 / $6,760.83
| Facility | | $933.25 | $3,630.78 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $194.98 / $363.08
| Professional | | $107.15 | $194.98 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $165.96 / $213.80
| Professional | | $93.33 | $165.96 | $213.80 |