- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,168.69 / $10,232.93
| Facility | | $2,041.74 | $4,168.69 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $7,079.46 / $10,964.78
| Professional | | $831.76 | $7,079.46 | $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
- $288.40 / $354.81 / $645.65
| Professional | | $288.40 | $354.81 | $645.65 |
- 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
- $2,398.83 / $5,128.61 / $11,481.54
| Facility | | $2,398.83 | $5,128.61 | $11,481.54 |