- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $15,488.17
| Facility | | $7,762.47 | $7,762.47 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $2,290.87 / $6,165.95
| Professional | | $169.82 | $2,290.87 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $13,803.84 / $22,908.68
| Facility | | $5,495.41 | $13,803.84 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $707.95
| Professional | | $588.84 | $588.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $512.86 / $870.96
| Professional | | $50.12 | $512.86 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $8,912.51 / $26,302.68
| Facility | | $891.25 | $8,912.51 | $26,302.68 |