- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $7,079.46 / $15,848.93
| Facility | | $6,606.93 | $7,079.46 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $16,595.87 / $16,595.87
| Professional | | $2,818.38 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,417.38 / $36,307.81 / $91,201.08
| Facility | | $20,417.38 | $36,307.81 | $91,201.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,908.68 / $23,988.33 / $23,988.33
| Professional | | $22,908.68 | $23,988.33 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $10,715.19 / $33,113.11
| Facility | | $5,128.61 | $10,715.19 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,309.57 / $13,182.57
| Facility | | $1,584.89 | $6,309.57 | $13,182.57 |