- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,370.32 / $10,715.19
| Facility | | $2,290.87 | $5,370.32 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $128.82 / $380.19
| Professional | | $93.33 | $128.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $43.65 / $190.55 / $309.03
| Professional | 52 | $43.65 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $436.52
| Professional | | $107.15 | $173.78 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $177.83 / $245.47
| Professional | | $120.23 | $177.83 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $954.99 / $1,513.56
| Facility | | $602.56 | $954.99 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $141.25 / $436.52
| Professional | | $85.11 | $141.25 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $138.04 / $263.03
| Professional | | $75.86 | $138.04 | $263.03 |