- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,606.93 / $14,791.08
| Facility | | $2,041.74 | $6,606.93 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $19,054.61
| Professional | | $933.25 | $933.25 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,760.83 / $9,332.54
| Facility | | $1,949.84 | $6,760.83 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,344.23 / $7,413.10
| Professional | | $1,949.84 | $2,344.23 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $12,022.64 / $18,620.87
| Facility | | $8,317.64 | $12,022.64 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $20,892.96 / $97,723.72
| Facility | | $3,630.78 | $20,892.96 | $97,723.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $18,620.87 / $102,329.30
| Facility | | $6,918.31 | $18,620.87 | $102,329.30 |