- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,332.54
| Facility | | $1,698.24 | $3,981.07 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,238.72 / $10,471.29
| Professional | | $676.08 | $2,238.72 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $128.82 / $204.17
| Professional | | $109.65 | $128.82 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50,118.72 / $50,118.72 / $53,703.18
| Facility | | $50,118.72 | $50,118.72 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $109.65 / $190.55
| Facility | | $77.62 | $109.65 | $190.55 |
- 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
- $1,318.26 / $2,754.23 / $4,897.79
| Facility | | $1,318.26 | $2,754.23 | $4,897.79 |