- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $9,332.54 / $17,782.79
| Facility | | $8,511.38 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $2,398.83 / $7,762.47
| Professional | | $575.44 | $2,398.83 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,302.69 / $20,417.38
| Facility | | $9,120.11 | $12,302.69 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,128.31 / $15,135.61
| Facility | | $6,760.83 | $8,128.31 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $12,302.69 / $15,848.93
| Facility | | $7,244.36 | $12,302.69 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $70.79
| Professional | | $32.36 | $50.12 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,302.69 / $16,218.10
| Facility | | $7,585.78 | $12,302.69 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Professional | | $34.67 | $34.67 | $34.67 |