- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,951.21 / $9,120.11
| Facility | | $562.34 | $2,951.21 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $912.01 / $1,949.84
| Professional | | $144.54 | $912.01 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $4,897.79 / $13,489.63
| Facility | | $1,819.70 | $4,897.79 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $363.08 / $1,819.70
| Professional | | $158.49 | $363.08 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $3,630.78 / $10,715.19
| Facility | | $177.83 | $3,630.78 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $977.24 / $2,818.38
| Professional | | $154.88 | $977.24 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,495.41 / $12,589.25
| Facility | | $1,778.28 | $5,495.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $891.25 / $2,041.74
| Professional | | $147.91 | $891.25 | $2,041.74 |