- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $7,943.28 / $16,595.87
| Facility | | $537.03 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $512.86 / $812.83
| Professional | | $251.19 | $512.86 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,495.41 / $10,232.93
| Facility | | $2,630.27 | $5,495.41 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $660.69
| Professional | | $363.08 | $467.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $478.63 / $912.01
| Professional | | $302.00 | $478.63 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $489.78 / $1,000.00
| Facility | | $309.03 | $489.78 | $1,000.00 |
- 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 / $11,220.18 / $17,378.01
| Facility | | $2,754.23 | $11,220.18 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $794.33
| Professional | | $263.03 | $436.52 | $794.33 |