- 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 / $18,197.01 / $18,197.01
| Professional | | $3,630.78 | $18,197.01 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $12,302.69 / $28,840.32
| Facility | | $5,888.44 | $12,302.69 | $28,840.32 |
- 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 / $13,489.63 / $23,988.33
| Facility | | $64.57 | $13,489.63 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $12,022.64 / $29,512.09
| Facility | | $3,630.78 | $12,022.64 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,218.10 / $46,773.51 / $69,183.10
| Professional | | $16,218.10 | $46,773.51 | $69,183.10 |