- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $9,772.37 / $20,892.96
| Facility | | $1,905.46 | $9,772.37 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $7,943.28
| Professional | | $676.08 | $676.08 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Professional | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $18,197.01 / $19,952.62
| Facility | | $7,943.28 | $18,197.01 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,964.78 / $33,884.42
| Facility | | $7,585.78 | $10,964.78 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $5,888.44 / $20,892.96
| Facility | | $676.08 | $5,888.44 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $8,912.51 / $17,378.01
| Facility | | $2,951.21 | $8,912.51 | $17,378.01 |