- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.84 / $17,590.08 / $27,999.78
| Facility | | $517.84 | $17,590.08 | $27,999.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.77 / $1,032.29 / $9,122.20
| Professional | | $470.77 | $1,032.29 | $9,122.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.31 / $564.26 / $614.78
| Facility | | $502.31 | $564.26 | $614.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.47 / $546.47 / $2,786.02
| Professional | | $546.47 | $546.47 | $2,786.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.44 / $805.44 / $805.44
| Facility | | $805.44 | $805.44 | $805.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.24 / $2,221.73 / $13,527.13
| Professional | | $490.24 | $2,221.73 | $13,527.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,298.85 / $11,298.85 / $33,915.76
| Facility | | $11,298.85 | $11,298.85 | $33,915.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,069.15 / $1,069.15 / $1,069.15
| Professional | | $1,069.15 | $1,069.15 | $1,069.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,887.16 / $8,137.22 / $12,670.84
| Professional | | $4,887.16 | $8,137.22 | $12,670.84 |