- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $64,565.42 / $66,069.34
| Facility | | $891.25 | $64,565.42 | $66,069.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $1,659.59
| Professional | | $851.14 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $21,379.62 / $43,651.58
| Facility | | $11,481.54 | $21,379.62 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,137.96 / $3,388.44
| Professional | | $1,288.25 | $2,137.96 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $20,417.38 / $38,018.94
| Facility | | $1,071.52 | $20,417.38 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $2,187.76
| Facility | | $891.25 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,902.95 / $35,481.34 / $46,773.51
| Facility | | $30,902.95 | $35,481.34 | $46,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,344.23 / $6,760.83
| Professional | | $977.24 | $2,344.23 | $6,760.83 |