- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $58,884.37 / $63,095.73
| Facility | | $45,708.82 | $58,884.37 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $1,584.89
| Professional | | $891.25 | $1,380.38 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,786.30 / $79,432.82
| Facility | | $2,344.23 | $4,786.30 | $79,432.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,230.27 / $3,630.78
| Professional | | $977.24 | $1,230.27 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,623.41 / $46,773.51
| Facility | | $1,071.52 | $5,623.41 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,412.54 / $1,698.24
| Professional | | $1,348.96 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,584.89 / $2,630.27
| Professional | | $977.24 | $1,584.89 | $2,630.27 |