- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,623.41 / $52,480.75
| Facility | | $1,202.26 | $5,623.41 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $1,479.11 / $4,570.88
| Professional | | $426.58 | $1,479.11 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $588.84 / $2,884.03
| Professional | | $389.05 | $588.84 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,772.37 / $9,772.37 / $9,772.37
| Facility | | $9,772.37 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $676.08
| Professional | | $630.96 | $630.96 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,862.09 / $4,073.80
| Professional | | $407.38 | $1,862.09 | $4,073.80 |