- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,772.90 / $15,285.18 / $36,770.58
| Facility | | $10,772.90 | $15,285.18 | $36,770.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.29 / $6,303.80 / $17,612.50
| Professional | | $512.29 | $6,303.80 | $17,612.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,762.11 / $13,974.32 / $28,953.21
| Facility | | $8,762.11 | $13,974.32 | $28,953.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.34 / $5,405.45 / $14,913.62
| Professional | | $490.34 | $5,405.45 | $14,913.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.97 / $392.80 / $7,462.91
| Facility | | $342.97 | $392.80 | $7,462.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.55 / $17,449.43 / $17,449.43
| Professional | | $1,187.55 | $17,449.43 | $17,449.43 |