- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $11,481.54 / $18,197.01
| Facility | | $7,943.28 | $11,481.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $575.44 / $912.01
| Professional | | $363.08 | $575.44 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,137.96 / $2,238.72
| Facility | | $1,737.80 | $2,137.96 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,988.33 / $23,988.33 / $30,902.95
| Facility | | $23,988.33 | $23,988.33 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $1,288.25
| Facility | | $389.05 | $575.44 | $1,288.25 |
- 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
- $537.03 / $1,023.29 / $1,949.84
| Professional | | $537.03 | $1,023.29 | $1,949.84 |