- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,748.09 / $12,456.66 / $24,809.40
| Facility | | $7,748.09 | $12,456.66 | $24,809.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.65 / $161.65 / $7,748.09
| Professional | | $80.65 | $161.65 | $7,748.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.14 / $186.85 / $6,552.05
| Professional | | $107.14 | $186.85 | $6,552.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.59 / $185.11 / $7,748.09
| Professional | | $111.59 | $185.11 | $7,748.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.54 / $188.76 / $6,399.20
| Professional | | $95.54 | $188.76 | $6,399.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,627.83 / $12,456.66 / $35,880.19
| Facility | | $6,627.83 | $12,456.66 | $35,880.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.42 / $155.66 / $7,748.09
| Professional | | $86.42 | $155.66 | $7,748.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,066.10 / $6,962.91 / $8,535.12
| Professional | | $5,066.10 | $6,962.91 | $8,535.12 |