- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.60 / $853.83 / $17,550.80
| Facility | | $654.60 | $853.83 | $17,550.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.83 / $16,177.70 / $24,177.30
| Professional | | $853.83 | $16,177.70 | $24,177.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.56 / $679.56 / $679.56
| Professional | | $679.56 | $679.56 | $679.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,845.86 / $2,337.42 / $37,473.97
| Professional | | $1,845.86 | $2,337.42 | $37,473.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.96 / $12,359.26 / $14,139.58
| Professional | | $933.96 | $12,359.26 | $14,139.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,948.88 / $27,571.20 / $59,787.85
| Facility | | $24,948.88 | $27,571.20 | $59,787.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.24 / $9,359.73 / $15,807.38
| Professional | | $417.24 | $9,359.73 | $15,807.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,932.48 / $11,603.28 / $30,372.59
| Professional | | $7,932.48 | $11,603.28 | $30,372.59 |