- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,405.80 / $21,144.87 / $33,649.15
| Facility | | $13,405.80 | $21,144.87 | $33,649.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $833.86 / $11,847.70 / $18,665.27
| Professional | | $833.86 | $11,847.70 | $18,665.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.09 / $13,450.14 / $30,516.93
| Facility | | $911.09 | $13,450.14 | $30,516.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,304.52 / $17,495.12 / $84,797.60
| Professional | | $12,304.52 | $17,495.12 | $84,797.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,073.53 / $23,073.53 / $23,073.53
| Facility | | $23,073.53 | $23,073.53 | $23,073.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,580.72 / $16,620.24 / $23,568.21
| Professional | | $11,580.72 | $16,620.24 | $23,568.21 |