- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,162.28 / $4,786.30
| Facility | | $912.01 | $3,162.28 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $537.03 / $3,019.95
| Professional | | $141.25 | $537.03 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $478.63 / $1,318.26
| Professional | | $181.97 | $478.63 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $933.25
| Professional | | $32.36 | $33.11 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,754.23 / $6,309.57
| Facility | | $2,344.23 | $2,754.23 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,467.37 / $4,073.80 / $9,549.93
| Facility | 50 | $3,467.37 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $363.08 / $1,174.90
| Professional | | $208.93 | $363.08 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $616.60 / $1,230.27
| Professional | | $154.88 | $616.60 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $851.14 / $1,348.96
| Professional | | $186.21 | $851.14 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,818.38 / $5,128.61
| Facility | | $1,096.48 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $501.19 / $1,258.93
| Professional | | $151.36 | $501.19 | $1,258.93 |