- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $11,748.98 / $25,118.86
| Facility | | $812.83 | $11,748.98 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $1,584.89
| Professional | | $676.08 | $676.08 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $41,686.94 / $50,118.72
| Facility | | $16,982.44 | $41,686.94 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $8,511.38 / $8,511.38
| Professional | | $977.24 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $9,549.93
| Facility | | $5,888.44 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $14,454.40 / $24,547.09
| Facility | | $8,912.51 | $14,454.40 | $24,547.09 |