- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,882.50 / $20,417.38
| Facility | | $7,943.28 | $12,882.50 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $575.44 / $676.08
| Professional | | $416.87 | $575.44 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,786.30 / $6,918.31
| Facility | | $4,073.80 | $4,786.30 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,982.44 / $30,902.95 / $54,954.09
| Facility | | $16,982.44 | $30,902.95 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $676.08 / $1,023.29
| Facility | | $549.54 | $676.08 | $1,023.29 |
- 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
- $8,317.64 / $22,387.21 / $37,153.52
| Facility | | $8,317.64 | $22,387.21 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,230.27
| Professional | | $549.54 | $758.58 | $1,230.27 |