- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,370.32 / $22,387.21
| Facility | | $2,398.83 | $5,370.32 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $269.15 / $302.00
| Professional | | $239.88 | $269.15 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $9,772.37 / $14,454.40
| Facility | | $8,709.64 | $9,772.37 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $3,981.07 / $5,623.41
| Professional | | $436.52 | $3,981.07 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $851.14 / $12,882.50
| Professional | | $371.54 | $851.14 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $1,047.13
| Professional | | $371.54 | $501.19 | $1,047.13 |