- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $13,803.84 / $33,113.11
| Facility | | $2,398.83 | $13,803.84 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $776.25 / $9,120.11
| Professional | | $676.08 | $776.25 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $17,378.01 / $38,018.94
| Facility | | $7,762.47 | $17,378.01 | $38,018.94 |
- 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
- $13,803.84 / $23,988.33 / $44,668.36
| Facility | | $13,803.84 | $23,988.33 | $44,668.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $50.12
| Professional | | $39.81 | $39.81 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $22,387.21 / $41,686.94
| Facility | | $7,413.10 | $22,387.21 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Professional | | $1,698.24 | $1,698.24 | $1,698.24 |