- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $6,918.31 / $11,220.18
| Facility | | $4,365.16 | $6,918.31 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $1,348.96 / $11,748.98
| Professional | | $223.87 | $1,348.96 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Professional | | $549.54 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $17,782.79 / $29,512.09
| Facility | | $11,481.54 | $17,782.79 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $8,709.64 / $21,379.62
| Facility | | $3,890.45 | $8,709.64 | $21,379.62 |