- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $16,218.10 / $38,018.94
| Facility | | $11,481.54 | $16,218.10 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $6,918.31 / $18,197.01
| Professional | | $512.86 | $6,918.31 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,302.69 / $15,488.17 / $30,199.52
| Facility | | $12,302.69 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $7,244.36 / $17,378.01
| Professional | | $501.19 | $7,244.36 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $11,220.18
| Facility | | $346.74 | $512.86 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $17,378.01 / $17,378.01
| Professional | | $1,174.90 | $17,378.01 | $17,378.01 |