- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,162.28 / $6,456.54
| Facility | | $1,288.25 | $3,162.28 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $5,128.61 / $8,912.51
| Professional | | $741.31 | $5,128.61 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,943.28 / $13,489.63
| Facility | | $2,238.72 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $2,570.40 / $13,803.84
| Professional | | $912.01 | $2,570.40 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $9,120.11
| Facility | | $9,120.11 | $9,120.11 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,905.46 / $10,964.78
| Professional | | $812.83 | $1,905.46 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,904.51 / $38,904.51 / $50,118.72
| Facility | | $38,904.51 | $38,904.51 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,904.51 / $45,708.82 / $45,708.82
| Professional | | $38,904.51 | $45,708.82 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $10,964.78 / $20,417.38
| Facility | | $6,456.54 | $10,964.78 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,778.28 / $11,481.54
| Professional | | $758.58 | $1,778.28 | $11,481.54 |