- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,754.23 / $11,481.54
| Facility | | $2,398.83 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $446.68 / $575.44
| Professional | | $257.04 | $446.68 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,481.34 / $39,810.72 / $39,810.72
| Facility | | $35,481.34 | $39,810.72 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $794.33 / $1,148.15
| Professional | | $331.13 | $794.33 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $891.25 / $1,122.02
| Professional | | $562.34 | $891.25 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $676.08 / $1,174.90
| Professional | | $389.05 | $676.08 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $12,589.25 / $12,589.25
| Facility | | $12,589.25 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $724.44 / $1,479.11
| Professional | | $524.81 | $724.44 | $1,479.11 |