- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $7,413.10 / $22,387.21
| Facility | | $1,318.26 | $7,413.10 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $6,456.54
| Professional | | $676.08 | $676.08 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $15,135.61 / $15,135.61
| Professional | | $151.36 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $19,498.45 / $33,884.42
| Facility | | $10,471.29 | $19,498.45 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $18,620.87 / $34,673.69
| Facility | | $10,471.29 | $18,620.87 | $34,673.69 |