- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,511.38 / $60,255.96
| Facility | | $3,162.28 | $8,511.38 | $60,255.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $12,589.25 / $41,686.94
| Facility | | $831.76 | $12,589.25 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $14,125.38 / $24,547.09
| Professional | | $1,096.48 | $14,125.38 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $60.26
| Professional | | $32.36 | $50.12 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40,738.03 / $40,738.03 / $40,738.03
| Facility | | $40,738.03 | $40,738.03 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $147.91 / $501.19
| Professional | | $112.20 | $147.91 | $501.19 |