- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,128.61 / $12,302.69
| Facility | | $3,162.28 | $5,128.61 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $5,495.41
| Facility | | $489.78 | $575.44 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Professional | | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,715.35 / $6,025.60
| Facility | | $2,511.89 | $3,715.35 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,819.70 / $6,309.57
| Facility | | $309.03 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $28,840.32 / $28,840.32
| Facility | | $56.23 | $28,840.32 | $28,840.32 |