- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $6,606.93 / $22,387.21
| Facility | | $1,412.54 | $6,606.93 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,584.89 / $6,165.95
| Professional | | $891.25 | $1,584.89 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,511.38 / $14,125.38
| Facility | | $6,606.93 | $8,511.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,370.32 / $11,220.18
| Facility | | $1,023.29 | $5,370.32 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $6,165.95 / $38,018.94
| Professional | | $707.95 | $6,165.95 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,951.21 / $30,902.95
| Facility | | $162.18 | $2,951.21 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Professional | | $7,762.47 | $7,762.47 | $7,762.47 |