- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $14,125.38 / $22,908.68
| Facility | | $3,981.07 | $14,125.38 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $158.49 / $7,079.46
| Professional | | $72.44 | $158.49 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $186.21 / $5,370.32
| Professional | | $79.43 | $186.21 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $204.17 / $10,715.19
| Professional | | $87.10 | $204.17 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $8,128.31 / $19,054.61
| Facility | | $4,466.84 | $8,128.31 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $3,715.35 / $8,709.64
| Professional | | $112.20 | $3,715.35 | $8,709.64 |