- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $4,786.30
| Facility | | $3,981.07 | $3,981.07 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,137.96 / $2,570.40
| Professional | | $1,174.90 | $2,137.96 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,772.37 / $275,422.87
| Facility | | $6,025.60 | $9,772.37 | $275,422.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,715.19 / $74,131.02
| Facility | | $4,466.84 | $10,715.19 | $74,131.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $2,951.21
| Professional | | $1,380.38 | $2,041.74 | $2,951.21 |