- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,025.60 / $10,715.19
| Facility | | $4,365.16 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $7,943.28 / $12,302.69
| Professional | | $3,090.30 | $7,943.28 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $33,884.42 / $52,480.75
| Facility | | $20,892.96 | $33,884.42 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $436.52
| Professional | | $371.54 | $371.54 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $8,317.64 / $25,118.86
| Facility | | $2,454.71 | $8,317.64 | $25,118.86 |