- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,022.64 / $18,197.01
| Facility | | $7,943.28 | $12,022.64 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $398.11
| Professional | | $251.19 | $346.74 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $31,622.78 / $64,565.42
| Facility | | $4,897.79 | $31,622.78 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $34,673.69
| Facility | | $26,915.35 | $26,915.35 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $416.87 / $741.31
| Facility | | $346.74 | $416.87 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $32,359.37 / $77,624.71
| Facility | | $4,365.16 | $32,359.37 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $501.19 / $870.96
| Professional | | $346.74 | $501.19 | $870.96 |