- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $6,025.60 / $11,220.18
| Facility | | $213.80 | $6,025.60 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $1,995.26 / $7,943.28
| Professional | | $141.25 | $1,995.26 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $16,218.10 / $41,686.94
| Facility | | $9,120.11 | $16,218.10 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,630.78 / $5,248.07
| Professional | | $3,467.37 | $3,630.78 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $14,125.38
| Facility | | $1,819.70 | $5,011.87 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $2,570.40 / $3,467.37
| Professional | | $602.56 | $2,570.40 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,309.57 / $12,589.25
| Facility | | $2,951.21 | $6,309.57 | $12,589.25 |