- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,265.80 / $10,964.78
| Facility | | $2,089.30 | $4,265.80 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $7,244.36 / $10,964.78
| Professional | | $831.76 | $7,244.36 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,888.44 / $12,302.69
| Facility | | $3,388.44 | $5,888.44 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $407.38
| Professional | | $181.97 | $223.87 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $50,118.72 / $53,703.18
| Facility | | $7,762.47 | $50,118.72 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,456.54 / $18,620.87
| Facility | | $2,511.89 | $6,456.54 | $18,620.87 |