- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $15,135.61 / $31,622.78
| Facility | | $8,912.51 | $15,135.61 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,621.81 / $2,398.83
| Professional | | $831.76 | $1,621.81 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,912.51 / $15,488.17
| Facility | | $5,011.87 | $8,912.51 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $54.95
| Professional | | $30.20 | $30.20 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $17,378.01 / $26,302.68
| Facility | | $6,309.57 | $17,378.01 | $26,302.68 |