- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,162.28 / $10,715.19
| Facility | | $524.81 | $3,162.28 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,479.11 / $2,884.03
| Professional | | $147.91 | $1,479.11 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,888.44 / $13,803.84
| Facility | | $3,019.95 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,659.59 / $3,981.07
| Professional | | $147.91 | $1,659.59 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $6,309.57 / $22,908.68
| Facility | | $251.19 | $6,309.57 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $954.99 / $4,570.88
| Professional | | $173.78 | $954.99 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,709.64 / $21,379.62
| Facility | | $2,884.03 | $8,709.64 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,202.26 / $3,388.44
| Professional | | $158.49 | $1,202.26 | $3,388.44 |