- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,511.38 / $16,218.10
| Facility | | $4,570.88 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $2,398.83 / $10,232.93
| Professional | | $707.95 | $2,398.83 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $17,378.01 / $36,307.81
| Facility | | $9,120.11 | $17,378.01 | $36,307.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,258.93 / $1,737.80
| Professional | | $467.74 | $1,258.93 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $23,988.33
| Professional | | $23,988.33 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $12,589.25 / $21,877.62
| Facility | | $8,912.51 | $12,589.25 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,584.89 / $24,547.09
| Professional | | $794.33 | $1,584.89 | $24,547.09 |