- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,606.93 / $38,904.51
| Facility | | $2,137.96 | $6,606.93 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $19,498.45 / $85,113.80
| Facility | | $10,471.29 | $19,498.45 | $85,113.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $14,791.08 / $19,498.45
| Facility | | $13,182.57 | $14,791.08 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $707.95 / $1,000.00
| Professional | | $6.46 | $707.95 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $13,489.63 / $36,307.81
| Facility | | $2,951.21 | $13,489.63 | $36,307.81 |