- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,548.13 / $10,964.78
| Facility | | $831.76 | $3,548.13 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,122.02 / $4,466.84
| Professional | | $426.58 | $1,122.02 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $6,025.60 / $16,595.87
| Facility | | $1,230.27 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $4,265.80
| Professional | | $0.02 | $0.02 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $7,244.36 / $21,379.62
| Facility | | $34.67 | $7,244.36 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,630.27 / $4,786.30
| Professional | | $741.31 | $2,630.27 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $1,071.52 / $3,630.78
| Facility | | $204.17 | $1,071.52 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $50.12 / $63.10
| Professional | | $34.67 | $50.12 | $63.10 |