- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $12,589.25 / $53,703.18
| Facility | | $4,677.35 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $776.25 / $10,964.78
| Professional | | $676.08 | $776.25 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $23,988.33 / $31,622.78
| Facility | | $8,912.51 | $23,988.33 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,709.64 / $10,471.29
| Professional | | $6,918.31 | $8,709.64 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $31,622.78 / $47,863.01
| Facility | | $13,803.84 | $31,622.78 | $47,863.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,547.09 / $24,547.09 / $24,547.09
| Facility | | $24,547.09 | $24,547.09 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $15,135.61 / $48,977.88
| Facility | | $9,332.54 | $15,135.61 | $48,977.88 |