- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,370.32 / $12,022.64
| Facility | | $1,862.09 | $5,370.32 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,964.78 / $10,964.78
| Professional | | $3,630.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $11,748.98 / $26,915.35
| Facility | | $5,623.41 | $11,748.98 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $295.12 / $331.13
| Professional | | $0.02 | $295.12 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $7,585.78 / $17,782.79
| Facility | | $64.57 | $7,585.78 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $27,542.29
| Facility | | $3,630.78 | $11,220.18 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,772.37 / $29,512.09 / $61,659.50
| Professional | | $9,772.37 | $29,512.09 | $61,659.50 |