- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,090.30 / $8,912.51
| Facility | | $630.96 | $3,090.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $1,412.54 / $2,818.38
| Professional | | $173.78 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,754.40 / $13,489.63
| Facility | | $2,089.30 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $1,621.81 / $3,981.07
| Professional | | $204.17 | $1,621.81 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $5,754.40 / $16,218.10
| Facility | | $34.67 | $5,754.40 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $794.33 / $4,570.88
| Professional | | $218.78 | $794.33 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $1,348.96 / $3,388.44
| Professional | | $186.21 | $1,348.96 | $3,388.44 |