- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $2,570.40 / $5,888.44
| Facility | | $660.69 | $2,570.40 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $1,023.29 / $7,244.36
| Professional | | $446.68 | $1,023.29 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $12,022.64 / $23,988.33
| Facility | | $6,309.57 | $12,022.64 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $870.96 / $7,585.78
| Professional | | $562.34 | $870.96 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $9,549.93 / $9,549.93
| Facility | | $39.81 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $794.33 / $7,244.36
| Professional | | $457.09 | $794.33 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $9,332.54 / $24,547.09
| Facility | | $1,202.26 | $9,332.54 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $4,073.80 / $8,912.51
| Professional | | $457.09 | $4,073.80 | $8,912.51 |