- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $7,244.36 / $16,595.87
| Facility | | $776.25 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $302.00 / $616.60
| Professional | | $257.04 | $302.00 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,623.41 / $10,471.29
| Facility | | $2,344.23 | $5,623.41 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $354.81 / $562.34
| Professional | | $239.88 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,235.94 / $4,168.69
| Facility | | $501.19 | $3,235.94 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $630.96
| Professional | | $281.84 | $380.19 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $645.65
| Facility | | $281.84 | $407.38 | $645.65 |
- 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
- $257.04 / $331.13 / $575.44
| Professional | | $257.04 | $331.13 | $575.44 |