- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,578.60 / $10,041.53 / $35,112.76
| Facility | | $7,578.60 | $10,041.53 | $35,112.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.81 / $663.20 / $7,578.60
| Professional | | $414.81 | $663.20 | $7,578.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.50 / $903.84 / $7,230.04
| Professional | | $519.50 | $903.84 | $7,230.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.86 / $907.18 / $10,927.46
| Professional | | $546.86 | $907.18 | $10,927.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.13 / $913.06 / $7,061.38
| Professional | | $462.13 | $913.06 | $7,061.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,041.53 / $10,041.53 / $35,112.76
| Facility | | $10,041.53 | $10,041.53 | $35,112.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.81 / $663.20 / $7,578.60
| Professional | | $414.81 | $663.20 | $7,578.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,927.37 / $6,507.03 / $8,410.43
| Professional | | $3,927.37 | $6,507.03 | $8,410.43 |