- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,456.54 / $14,454.40
| Facility | | $3,548.13 | $6,456.54 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $7,079.46 / $8,912.51
| Professional | | $831.76 | $7,079.46 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,908.68 / $27,542.29 / $33,884.42
| Facility | | $22,908.68 | $27,542.29 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $8,511.38 / $19,054.61
| Facility | | $1,905.46 | $8,511.38 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $977.24 / $72,443.60
| Professional | | $676.08 | $977.24 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $10,232.93 / $16,218.10
| Facility | | $2,570.40 | $10,232.93 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $2,344.23
| Professional | | $660.69 | $977.24 | $2,344.23 |