- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $5,128.61 / $12,302.69
| Facility | | $741.31 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $416.87 / $1,047.13
| Professional | | $323.59 | $416.87 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $8,511.38 / $18,197.01
| Facility | | $3,090.30 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $512.86 / $933.25
| Professional | | $309.03 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,691.53 / $16,982.44
| Facility | | $630.96 | $2,691.53 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,202.26
| Professional | | $371.54 | $575.44 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $831.76
| Professional | | $331.13 | $467.74 | $831.76 |