- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,162.28 / $9,772.37
| Facility | | $602.56 | $3,162.28 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $489.78 / $3,467.37
| Professional | | $181.97 | $489.78 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,248.07 / $26,915.35
| Facility | | $2,238.72 | $5,248.07 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $407.38 / $1,148.15
| Professional | | $144.54 | $407.38 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $11,481.54 / $29,512.09
| Facility | | $776.25 | $11,481.54 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $630.96 / $6,760.83
| Professional | | $204.17 | $630.96 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $9,332.54 / $29,512.09
| Facility | | $2,951.21 | $9,332.54 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $426.58 / $3,467.37
| Professional | | $177.83 | $426.58 | $3,467.37 |