- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,162.28 / $9,772.37
| Facility | | $537.03 | $3,162.28 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $457.09 / $3,019.95
| Professional | | $177.83 | $457.09 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,370.32 / $26,915.35
| Facility | | $2,511.89 | $5,370.32 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $346.74 / $2,398.83
| Professional | | $123.03 | $346.74 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $5,011.87 / $16,218.10
| Facility | | $194.98 | $5,011.87 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $537.03 / $4,466.84
| Professional | | $199.53 | $537.03 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $26,915.35
| Facility | | $3,019.95 | $8,912.51 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $389.05 / $2,884.03
| Professional | | $165.96 | $389.05 | $2,884.03 |